New recommendations on managing of diabetes with comorbid osteoporosis

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Thiazolidinediones and canagliflozin should be avoided and insulin should be used with caution.

While type 2 diabetes (T2D) and osteoporosis often coexist in patients, most studies focus on managing the diseases separately. Following a comprehensive review of the relevant literature, a review of existing evidence to identify the most effective treatment options for managing the conditions together.

The authors of the review, published in the  Journal of Clinical Endocrinology & Metabolism , stress that the treatment and monitoring of osteoporosis should be continued without important changes because of the existence of T2D. They recommend metformin, sulfonylureas, DPP-4 inhibitors and GLP1 receptor agonists as the preferred treatment for T2D in patients who also have osteoporosis, but say strict targets should be avoided for fear of hypoglycaemia, falls and fractures.

Thiazolidinediones (TZDs) and canagliflozin should be avoided while other SGLT2 inhibitors are less well-validated options, the authors say. Insulin should be used with caution and with careful measures to avoid hypoglycaemia. The authors recommend however that insulin therapy is the preferred method for achieving glycaemic control in patients who are hospitalised with T2D and fractures.

The team found no evidence of any detrimental effects of osteoporosis medications on glucose metabolism, but a possible beneficial effect was observed with the use of bisphosphonates.

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