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Review
. 2025 Jul 21;25(1):43.
doi: 10.1007/s11892-025-01599-x.

Optimizing Bone Health in Diabetes: Strategies for Fracture Risk Reduction in Public Healthcare

Lakshmi Nagendra  1   2 , Khushboo Agarwal  3 , Shinjan Patra  4 , Saptarshi Bhattacharya  5 , Latika Gupta  6   7   8 , Nishka Talwar  9 , Aditya Rao  10 , Amit Gupta  11 , A B M Kamrul-Hasan  12 , Deep Dutta  13 , Mickael Hiligsmann  14 , Manju Chandran  15   16
Affiliations
Review

Optimizing Bone Health in Diabetes: Strategies for Fracture Risk Reduction in Public Healthcare

Lakshmi Nagendra et al. Curr Diab Rep. .

Abstract

Purpose of review: In this review, we explore the under-recognized burden of fractures in diabetes, focusing on resource-constrained healthcare systems. We examine the epidemiology, assessment methodologies, and management approaches to osteoporosis in diabetes and discuss strategies to improve skeletal health outcomes.

Recent findings: Public healthcare strategies for fracture risk reduction in diabetes include educating healthcare providers, empowering patients, and integrating fracture liaison services for secondary prevention. Community-based awareness programs, digital health solutions, and screening tools such as FRAX® (with diabetes-specific adjustments) facilitate early identification and management. Policies supporting insurance coverage and cost-effective management strategies are likewise crucial. Diabetes-related bone fragility, characterized by altered bone quality and increased fracture risk despite relatively preserved bone density, creates a significant yet underrecognized health burden. Fracture prevention in diabetes is both a clinical necessity and an economic imperative. In this expanding cohort, multidisciplinary, policy-supported strategies can reduce morbidity, mortality, and costs associated with fragility fractures.

Keywords: Diabetes; Fracture liaison services, cost-effectiveness; Fracture prevention; Osteoporosis; Public healthcare.

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Conflict of interest statement

Declarations. Competing interests: The authors declare no competing interests. Human and Animal Rights: This article does not contain any studies with human or animal subjects performed by any of the authors. Disclosures: The views and opinions expressed are solely those of the authors and do not represent or reflect those of any affiliated institutions.

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References

    1. Starup-Linde J, Frost M, Vestergaard P, Abrahamsen B. Epidemiology of fractures in diabetes. Calcif Tissue Int. 2017;100(2):109–21. - PubMed
    1. Wu B, Fu Z, Wang X, Zhou P, Yang Q, Jiang Y, et al. A narrative review of diabetic bone disease: Characteristics, pathogenesis, and treatment. Front Endocrinol. 2022;14(13):1052592.
    1. Wongdee K, Charoenphandhu N. Osteoporosis in diabetes mellitus: Possible cellular and molecular mechanisms. World J Diabetes. 2011;2(3):41–8. - PubMed - PMC
    1. Chandran M, Aftab N, Amin A, Amphansap T, Bhadada SK, Chadha M, et al. Evaluating compliance with the care standard of proactively assessing bone health in patients with diabetes: a pilot audit of practice across Asia by the Asia Pacific Consortium on Osteoporosis (APCO). Arch Osteoporos. 2024;19(1):48. - PubMed - PMC
    1. Ferrari SL, Abrahamsen B, Napoli N, Akesson K, Chandran M, Eastell R, et al. Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int. 2018;29(12):2585–96. - PubMed - PMC

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