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NOFSA 2024 Masterclass Series: Diabetes and Osteoporosis


A confluence of increasing ageing and diabetes prevalence will increase fracture incidence, as both have effects on bone quality and quantity. Explore diabetes-related osteoporosis risk factors and understand the clinical approach to assessing fracture risk and managing osteoporosis in diabetic patients.

About our experts

Dr Zane Stevens
Adult Endocrinologist

Christiaan Barnard Memorial Hospital, Cape Town MBChB cum laude, MMED, FCP (SA),
Fellowship in Endocrinology & Metabolism

Dr Zane Stevens is an Endocrinologist at the Cape Institute of Endocrinology, Cape Town, with expertise in diabetes, thyroid disease, and osteoporosis. He's contributed to medical guidelines, co-authoring chapters in SEMDSA guidelines and the Tropical Handbook of Medicine.

Dr Stevens is actively involved in training, serving as an examiner for Endocrinology & Metabolism. He's also a founding member of the Cape Thyroid Forum MDT and speaks regularly at CME events.

Learning objectives

You will gain an understanding of:

  • The epidemiological link between diabetes and fracture risk
  • How bone mineral density (BMD) and bone quality are impacted by diabetes
  • Current clinical approaches to assessing fracture risk and for the management of osteoporosis in patients with diabetes.

Key learnings

  • Prevalence of both diabetes and osteoporosis is increasing worldwide, partly owing to ageing populations.
  • Patients with T1DM or T2DM have an increased fracture risk that changes in BMD alone do not account for some antidiabetic medications, especially thiazolidinediones, may contribute to increased risk of fracture.
  • Most currently available fracture risk assessment tools may, in the setting of diabetes, underestimate fracture risk; this is especially true of FRAX in T2DM.
  • Several methods have been developed to mitigate this risk, e.g. including RA or FRAX Plus.
  • Antiresorptive agents are recommended as first-line osteoporosis therapy for patients with diabetes although anabolic steroids may be preferred for those at very high fracture risk.