Bone metabolism in diabetes: a clinician’s guide to understanding the bone–glucose interplay – published online 18/05/2024

Angela Sheu, Christopher P. White, Jacqueline R. Center

People with diabetes are more likely to suffer from fragility fractures than those without diabetes, leading to worse post-fracture complications including poor fracture healing, infections and increased mortality risk. However, quantifying fracture risk in diabetes is difficult, as standard clinical measurements of bone mineral density and fracture risk calculators underestimate risk in this population. In this issue (https://doi.org/10.1007/s00125-024-06172-x), Sheu et al discuss how elucidating metabolic–bone interactions, including determining diabetes-related clinical predictors for fractures and underlying pathophysiological drivers, provides a rationale for changing from a bone-centric paradigm to a diabetes-centric approach when considering the optimal assessment and management of diabetic bone disease. The authors conclude that further clinical characterisation of diabetic osteopathy may reveal new targets for improving skeletal-related outcomes in people with diabetes. The figures from this review are available as a downloadable slideset.