[Diabetes mellitus and osteoporosis. How to start drug therapy for osteoporosis in patients with diabetes mellitus].

Drug treatment for osteoporosis is intended to prevent osteoporotic fractures. Physicians should assess fracture risk in patients with diabetes not only by measuring bone mineral density (BMD) but also by taking a fracture history and evaluating prior vertebral fractures using spinal X-rays when starting drug therapy. Accumulating evidence shows that patients with diabetes (DM) have a high risk for fragility fractures independent of BMD. Thus, when DM patients have osteopenia, fracture risk could become higher than non-DM counterparts, and drug therapy should be considered to prevent fragility fractures. The criteria for starting drug treatment to prevent fragility fractures in DM patients, albeit tentative, are shown in this article.