Jawl-Shan Hwang Taiwan

• New Concept in Osteoporosis Management
  Daisuke InoueJapan Speaker New Concept in Osteoporosis Management- Japnaese Perspectives Operational definition of osteoporosis by WHO is currently "a BMD value -2.5SD or more below the young adult mean", which has been used worldwide for twenty years. WHO has recently initiated a process to revisit this definition as it is not sensitive enough to identify individuals at high risk of fracture, leading to unsatisfactory treatment of patients. Importantly, a history of fracture, particularly within the past two years (termed imminent fracture risk) has been shown to significantly contribute to the risk of subsequent fractures. Regarding a surrogate for evaluating the clinical efficacy of anti-osteoporotic drugs, a proposal from the FNIH-ASBMR-SABRE project has been submitted to the Food and Drug Administration (FDA). This proposal suggests that treatment-related increases in total hip BMD (TH-BMD) at two years could serve as a surrogate endpoint for fracture risk reduction in clinical trials. This is primarily based on the negative correlation observed between increases in total hip BMD and decreases in the incidence of hip fracture in various clinical trials of anti-osteoporotic drugs demonstrated by a meta-regression analysis. The significant role of BMD as a surrogate, along with availability of bone anabolic agents that can greatly increase BMD for a short period of time, has led to the concept of "Goal-directed treatment" of osteoporosis. Accordingly, "anabolic first" sequential therapy is recommended for individuals at high risk of fractures. In Japan, new Guidelines for Prevention and Treatment of Osteoporosis were issued on August 1, 2025. Recent trends in osteoporosis management, as described above, will be discussed in the context of these Japanese guidelines.
• 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.
• Metabolic Bone Disorder in Thalassemia
  Wen-Pin YangTaiwan Speaker Metabolic Bone Disorder in ThalassemiaIntroduction: Thalassemia-associated osteoporosis (TAO) is a prevalent and debilitating complication in adult patients with β-thalassemia major (β-TM), despite advancements in transfusion and chelation therapies. Given the complexity of its pathogenesis, TAO presents a unique challenge to endocrinologists, requiring a nuanced understanding of the interplay between ineffective erythropoiesis, iron overload, and the endocrine axis. Pathogenesis & Endocrine Involvement: The aetiology of TAO is multifactorial. Chronic ineffective erythropoiesis leads to bone marrow expansion, causing mechanical disruption of the trabecular microarchitecture. Simultaneously, systemic iron overload (hemosiderosis) exerts direct toxicity on osteoblasts and induces secondary endocrine failures. Clinical evidence demonstrates that BMD in β-TM patients is significantly correlated with multiple endocrine parameters: it is negatively associated with TSH, HbA1c, iPTH, and FGF23 levels, while positively correlating with testosterone and IGF-1. Pituitary and thyroid hemosiderosis are major drivers of impaired peak bone mass accrual and accelerated bone loss. Diagnostic Considerations: While Dual-energy X-ray absorptiometry (DXA) remains the standard for monitoring, its accuracy is often limited by scoliosis, vertebral deformities, and marrow expansion. Complementary tools, such as bone turnover markers (CTX and P1NP) and opportunistic QCT, are essential for a comprehensive skeletal assessment and for identifying patients at high risk for fragility fractures. Therapeutic Strategies: Management requires a multidisciplinary approach beyond optimizing iron chelation and Vitamin D status. Antiresorptive agents, particularly Zoledronate and Denosumab, are effective in increasing BMD and reducing bone pain. However, in severe cases with prevalent fractures, anabolic therapy with Teriparatide has demonstrated superior efficacy, with significant BMD gains in both the lumbar spine and femoral neck. This presentation will emphasize the "sequential therapy" model—initiating with anabolic agents followed by antiresorptives—to maximize and maintain skeletal recovery. Conclusion: TAO requires lifelong vigilance and a tailored treatment plan. Early intervention targeting endocrine deficiencies and the strategic application of sequential pharmacological therapies are vital to preventing fractures and improving the quality of life for this aging population.

• Assessing and Managing Osteoporosis in Patients with Diabetes
  Jawl-Shan HwangTaiwan Speaker Assessing and Managing Osteoporosis in Patients with Diabetes
• Diabetes and Osteoarthritis: Metabolic Links and Clinical Implications
  Jia-Feng ChenTaiwan Speaker Diabetes and Osteoarthritis: Metabolic Links and Clinical Implications
• Sarcopenia in Diabetes: Pathophysiology, Diagnosis, and Management
  Tung-Wei KaoTaiwan Speaker Sarcopenia in Diabetes: Pathophysiology, Diagnosis, and Management Sarcopenia is emerging as a critical yet under-recognized dimension of diabetes, linking metabolic disease to progressive loss of muscle health and physical function. Beyond its traditional association with ageing, growing evidence shows that diabetes is linked to accelerated declines in muscle mass, strength, and physical performance. These changes have important clinical consequences, contributing to frailty, disability, and loss of independence. As the global burden of diabetes continues to rise, maintaining skeletal muscle health is becoming an increasingly important component of diabetes care. Recent advances in metabolic and musculoskeletal research have begun to illuminate the biological links between diabetes and accelerated muscle deterioration. Alterations in insulin signaling, ectopic fat accumulation within skeletal muscle, chronic low-grade inflammation, and mitochondrial dysfunction are increasingly recognized as converging pathways that compromise muscle quality and function. At the same time, new consensus frameworks—including the Asian Working Group for Sarcopenia 2025 update—have expanded the concept from sarcopenia alone toward a broader focus on muscle health across the lifespan. Importantly, emerging clinical evidence suggests that sarcopenia in diabetes is not merely a consequence of ageing but a potentially modifiable condition. Interventions such as resistance exercise, structured physical activity, and targeted nutritional strategies have shown promising benefits in improving muscle strength and functional capacity in individuals with diabetes. As the global burden of diabetes continues to rise, understanding the bidirectional relationship between metabolic disease and skeletal muscle health is becoming increasingly relevant for clinical practice. This lecture will review current perspectives on sarcopenia in diabetes, highlighting key mechanistic insights, evolving diagnostic approaches, and the growing body of evidence supporting preventive and therapeutic strategies aimed at preserving muscle health in this high-risk population.