[Body weight and bone/calcium metabolism. Glucose-lowering agents and fracture risk.]

Diabetes is associated with increased fracture risk, involving a variety of factors. Besides poor glycemic control itself, some glucose-lowering agents are also associated with increased fracture risk. Thiazolidinediones increase fracture risk probably through inhibition of bone formation as well as increased resorption leading to decreased BMD. Sodium-glucose cotransporter(SGLT)-2 inhibitors have been reported to decrease BMD and increase fracture risk. However, the class effect of SGLT-2 inhibitors on bone metabolism remains to be established. In diabetic patients, especially in those with high fracture risk such as postmenopausal women, careful selection of glucose-lowering agents as well as appropriate and timely intervention for osteoporosis is necessary.