Published online Aug 15, 2019. doi: 10.4239/wjd.v10.i8.421
Peer-review started: April 8, 2019
First decision: May 9, 2019
Revised: June 3, 2019
Accepted: July 20, 2019
Article in press: July 20, 2019
Published online: August 15, 2019
Core tip: Diabetes mellitus, either type 1 or type 2, is associated with increased fracture risk. Diabetic hyperglycemia and insulin resistance underlie functional alterations of bone cells and bone marrow fat that affect several determinants of bone strength, including bone matrix proteins and bone mass, geometry and microarchitecture. Diabetes-related microvascular complications and certain antidiabetic drugs appear to further increase fracture risk, both directly and indirectly. The prevention and management of bone fragility in diabetes includes identification of patients at risk, correction of modifiable risk factors including appropriate choice of antidiabetic drugs and use of antifracture drugs with proven efficacy.