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ISO2026: Diabetes and Bone Health
This session examines the relationship between diabetes and skeletal fragility across both type 1 and type 2 diabetes. It opens with the epidemiology of fracture in diabetes, including the increased risk of hip fracture and the worse outcomes that follow fracture, such as higher mortality and reduced recovery of walking ability. The session then addresses the apparent paradox of type 2 diabetes, in which bone mineral density measured by dual energy x-ray absorptiometry is preserved or elevated while fracture risk is increased. It reviews the multiple determinants of that risk, including a higher frequency of falls, greater skeletal loading forces, deficits in cortical microarchitecture, reduced trabecular bone score, a low bone turnover state, accumulation of advanced glycation endproducts, and skeletal microangiopathy. The discussion contrasts these findings with the distinct phenotype of type 1 diabetes, which is characterized by lower bone mineral density, absolute insulin deficiency, altered hip geometry, and the compositional and biomechanical deficits demonstrated in recent cohort and cadaveric studies. The session also evaluates the skeletal effects of glucose lowering therapies, including thiazolidinediones, sodium glucose cotransporter 2 inhibitors, insulin, and GLP-1 receptor agonists, with attention to the differing bone outcomes observed at glycemic versus weight loss dosing. It closes with clinical implications drawn from the current American Diabetes Association standards of care, including screening considerations, the limitations of FRAX in this population, treatment thresholds, fall prevention, and evidence that antiresorptive and anabolic agents protect the skeleton comparably in patients with and without diabetes.
Target Audience
This continuing education activity is intended for use by health professionals who participate in the care of patients at risk for or suffering from osteoporosis, in the areas of primary care, endocrinology, geriatrics, gynecology, internal, obstetrics, orthopedics, osteopathy, pediatrics, physiatry, radiology, rheumatology and physical therapy.
This includes physicians, nurse practitioners, registered nurses, pharmacists, physician assistants, technologists, researchers, public health professionals and health educators with an interest in osteoporosis and bone health.
Learning Objectives
Upon completion of this session, participants will be able to:
1. Describe the magnitude of increased fracture risk in adults with type 1 and type 2 diabetes, including the elevated risk of hip fracture and the worse clinical outcomes that follow fracture in this population.
2. Explain the paradox of preserved or elevated bone mineral density alongside increased fracture risk in type 2 diabetes, and identify the structural, compositional, biomechanical, and extrinsic factors that contribute to skeletal fragility.
3. Differentiate the skeletal phenotypes and underlying mechanisms of bone fragility in type 1 versus type 2 diabetes.
4. Evaluate the effects of glucose lowering medications, including thiazolidinediones, sodium glucose cotransporter 2 inhibitors, insulin, and GLP-1 receptor agonists, on bone mineral density and fracture risk.
5. Apply diabetes specific adjustments to fracture risk assessment, recognizing that FRAX underestimates risk in diabetes, and select appropriate screening and treatment strategies for patients with diabetes
Name of Individual | Individual's Role(s) in Activity | Name of Ineligible Company(s) | Nature of Relationship(s) |
| Elaine Yu, MD, MMSc | Speaker | N/A | N/A |
| Amy Mitchell, MSN, FNP-C | Planner/Accredited Provider Program Director & Content Expert | Amgen & Radius Health | Speaker’s Bureau, Scientific Advisory Board, Consulting |
Ami Patel | BHOF Staff, Vice President of Science & Education | N/A | N/A |
Andrea Medeiros | BHOF Staff, Vice President of Public Health & Policy | N/A | N/A |
Disclosures:
• Consulting: Abbvie
• Research grant: Amgen
• Stocks: Opko
• Royalties: UpToDate
Accreditation Statement
The Bone Health and Osteoporosis Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
The Bone Health and Osteoporosis Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation.
CME Program Eligibility
Method of Participation in the Learning Process: Clinician learners will view and analyze the subject matter, conduct additional informal research through related internet searches on the subject matter, and complete a post-test assessment of knowledge and skills gained as a result of the activity.
After participating in this activity, the reader has the option of taking an evaluation for this activity. It is estimated it will take 1.0 hour(s) to complete the reading and take the evaluation. Continuing education credit will be available for two years from the date of publication.
Disclosure of Commercial Support
It is the policy of the Bone Health & Osteoporosis Foundation (BHOF) to ensure balance, independence, objectivity, and scientific rigor in all its sponsored publications and programs. BHOF requires the disclosure of the existence of any significant financial interest or any other relationship the sponsor, Editorial Board or Guest Contributors have with the manufacturer(s) of any commercial product(s) discussed in an educational presentation. All authors and contributors to this continuing education activity have disclosed any real or apparent interest that may have direct bearing on the subject matter of this program.
Please be advised that BHOF’s accreditation status with ACCME and ANCC does not imply endorsement by BHOF, ACCME or ANCC of any commercial products displayed in conjunction with this activity or endorsement of any point of view.
Refund Policy
BHOF offers no returns or refunds on online internet CME activities purchased through our store. All sales are final. Meeting and workshop registrations will be refunded in accordance with the cancellation policy of the meeting and/or workshop, as outlined at registration.
Available Credit
- 1.00 AMA PRA Category 1 Credit™The National Osteoporosis Foundation is an approved Accreditation Council for Continuing Medical Education (ACCME) accredited CME provider through March 2023. ACCME accreditation accelerates learning, change and improvement in the field of osteoporosis. The National Osteoporosis Foundation is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The National Osteoporosis Foundation designates educational activities for AMA PRA Category 1 Credit™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
- 1.00 ANCCThe mission of the American Nurses Credentialing Center (ANCC), a subsidiary of the American Nurses Association (ANA), is to promote excellence in nursing and health care globally through credentialing programs. The National Osteoporosis Foundation is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The National Osteoporosis Foundation designates educational activities for continuing nursing education credit(s).
- 1.00 Participation
- 1.00 Participation/AttendanceA certificate of attendance will be provided to all other attending healthcare professionals. Nurse practitioners and physician assistants may request AMA PRA Category 1 Credit(s)™ certificate of participation. Please refer to your provider to determine whether this program will qualify for other categories of continuing education credits. The American Academy of Physician Assistants (AAPA) also accepts educational activities certified for AMA PRA Category 1 Credit™ from organizations accredited by the Accreditation Council for Continuing Education (ACCME).