Diabetic women at risk for atypical osteoporosis. (Higher Rate of Fractures).

NEW YORK -- Women with type 2 diabetes appear to develop an atypical form of osteoporosis, Dr. Michael Kleerekoper said at a conference sponsored by the American Diabetes Association.

These women tend to have fractures at atypical sites, to experience a higher rate of fractures than do nondiabetic women of similar age and size, and to sustain fractures that are not fully accounted for by abnormalities in bone remodeling, said Dr. Kleerekoper, professor of medicine and obstetrics and gynecology at Wayne State University, Detroit.

The well-established protective effect of obesity against osteoporosis does not appear to play out in diabetic women, who have higher fracture rates than nondiabetics despite being heavier and having higher bone mineral densities (BMDs).

The reasons for this "diabetic osteopathy" paradox are not yet clear. Most studies addressing osteoporosis and fractures in diabetic women have been small, cross-sectional, and inconsistent with one another, Dr. Kleerekoper said.

Despite the lack of data, there is no reason to believe that osteoporosis therapies such as alendronate, calcitonin, raloxifene, and risedronate would not be effective in women with diabetes. But determining when to initiate these therapies in diabetic women is problematic, since their fractures occur at higher (BMDs) than in non-diabetics, he noted.

Patients with impaired vision or peripheral neuropathy probably should be considered for osteoporosis therapy even when their BMD is not yet low. Those who have already sustained one or more fragility fractures also are candidates for therapy. But bisphosphonates should be used with caution in patients with diabetic gastroparesis. Of course, optimal diabetes control is a necessary prerequisite to reducing fracture risk, he added.

In one of the few large prospective ...