Bone Fragility in Diabetes

David LuiHong Kong, China Speaker Bone Fragility in DiabetesDiabetes and osteoporosis are emerging as major public health challenges across Asia, constituting a dual epidemic with significant individual and societal impacts. The Asia-Pacific region accounts for over one-third of the global diabetes population, while osteoporosis-related fractures pose a substantial burden, with one in three women and one in five men over 50 experiencing osteoporotic fractures in their lifetime. Evidence indicates a high fracture burden in Asia, compounded by the increased fragility and poorer outcomes observed in individuals with diabetes. This session will address the urgent need to optimize bone health in the context of the Asian diabetes epidemic. Despite recognition of the increased fracture risk among people with diabetes, the persistent gap representing diabetes-related excess fracture risk appears to remain. A multifaceted approach is needed to address this issue. Key strategies include achieving and maintaining optimal glycaemic control – targeting hyperglycemia, minimizing hypoglycemia, and reducing glycaemic variability – and early intervention for diabetes to reduce occurrence of diabetic complications which in turn are associated with fracture risks. Notably, individuals with type 2 diabetes often fracture at higher bone density T-scores than their non-diabetic counterparts, suggesting that the intervention threshold may need to be modified in this population. Proactive osteoporosis management is essential. Moreover, the high prevalence of coexisting cardiovascular and metabolic comorbidities in individuals with diabetes influences fracture risk, with medication choices potentially impacting skeletal health. Overall, it is hoped that a comprehensive approach integrating glycaemic optimization, proactive osteoporosis management and managing cardiometabolic comorbidities can address this Asian epidemic of diabetes and osteoporosis.