Executive summary of clinical practice guide on fracture risk in lifestyle diseases
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Executive summary of clinical practice guide on fracture risk in lifestyle diseases Ippei Kanazawa1 · Masaaki Inaba2 · Daisuke Inoue3 · Kazuhiro Uenishi4 · Mitsuru Saito5 · Masataka Shiraki6 · Atsushi Suzuki7 · Yasuhiro Takeuchi8 · Hiroshi Hagino9 · Saeko Fujiwara10 · Toshitsugu Sugimoto11 · from the Japan Osteoporosis Society Lifestyle diseases-related Fracture Risk Investigation Committee Received: 2 June 2020 / Accepted: 23 August 2020 © The Japanese Society Bone and Mineral Research and Springer Japan KK, part of Springer Nature 2020
Abstract Accumulating evidence has shown that patients with lifestyle diseases such as type 2 diabetes mellitus, chronic kidney disease, and chronic obstructive pulmonary disease are at increased risk of osteoporotic fracture. Fractures deteriorate quality of life, activities of daily living, and mortality as well as a lifestyle disease. Therefore, preventing fracture is an important issue for those patients. Although the mechanism of the lifestyle diseases-induced bone fragility is still unclear, not only bone mineral density (BMD) reduction but also bone quality deterioration are involved in it. Because fracture predictive ability of BMD and FRAX® is limited, especially for patients with lifestyle diseases, the optimal management strategy should be established. Thus, when the intervention of the lifestyle diseases-induced bone fragility is initiated, the deterioration of bone quality should be taken into account. We here review the association between lifestyle diseases and fracture risk and proposed an algorism of starting anti-osteoporosis drugs for patients with lifestyle diseases. Keywords Guide · Diabetes mellitus · Chronic kidney disease · Chronic obstructive pulmonary disease · Bone quality
Objective of and background to the preparation of this clinical guide In recent years, it is considered that bone strength is determined by not only bone mineral density (BMD) but also bone quality. Accumulative evidence has shown that lifestyle diseases such as type 2 diabetes mellitus (T2DM), chronic kidney disease (CKD), and chronic obstructive pulmonary disease (COPD), cause bone fragility independently of BMD * Ippei Kanazawa ippeikanazawa@kanazawa‑doc.com 1
Kanazawa Diabetes and Osteoporosis Clinic, 990‑2‑1 Enya‑cho, Izumo, Shimane 693‑0021, Japan
Department of Metabolism, Endocrinology, and Molecular Medicine, Osaka City University Graduate School of Medicine, Osaka, Japan
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reduction and result in increased fracture risk. However, the fact that lifestyle diseases are associated with fracture risk has not been widely recognized. It thus seems important and necessary to raise awareness and understanding of general physicians about the lifestyle diseases-related fracture risk and its management. In a Japanese guideline for the prevention and treatment of osteoporosis 2015 edition [1], lifestyle diseases-related osteoporosis was stated as a major secondary osteoporosis, 6
Research Institute and Practice for Involutional Diseases, Na
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