Diagnosing Osteoporosis in Diabetes—A Systematic Review on BMD and Fractures

Purpose of Review Recently, the American Diabetes Association updated the 2024 guidelines for Standards of Care in Diabetes and recommend that a T -score of − 2.0 in patients with diabetes should be interpreted as equivalent to − 2.5 in people without diabetes. We aimed to evaluate the most recent findings concerning the bone mineral density (BMD)-derived T -score and risk of fractures related to osteoporosis in subjects with diabetes. Recent Findings The dual-energy X-ray absorptiometry (DXA) scan is the golden standard for evaluating BMD. The BMD-derived T -score is central to fracture prediction and signifies both diagnosis and treatment for osteoporosis. However, the increased fracture risk in diabetes is not sufficiently explained by the T -score, complicating the identification and management of fracture risk in these patients. Summary Recent findings agree that subjects with type 2 diabetes (T2D) have a higher T -score and higher fracture risk compared with subjects without diabetes. However, the actual number of studies evaluating the direct association of higher fracture risk at higher T -score levels is scant. Some studies support the adjustment based on the 0.5 BMD T -score difference between subjects with T2D and subjects without diabetes. However, further data from longitudinal studies is warranted to validate if the T -score treatment threshold necessitates modification to prevent fractures in subjects with diabetes.