糖尿病合併骨粗鬆症の治療

Body weight and bone/calcium metabolism. Treatment of osteoporosis with diabetes.

　骨粗鬆症治療の三本柱は，他の生活習慣病と同様に，栄養・運動・薬物療法である。糖尿病を合併した骨粗鬆症患者では，体重の減量による骨量減少リスク，エネルギー摂取制限に伴うカルシウム摂取量の減少などに留意する必要がある。糖尿病患者では，網膜症や神経障害などにより転倒リスクが高まるため，運動療法では，転倒予防に配慮した指導を行うことで，骨折リスクの低減をはかる。薬物療法に関しては，糖尿病関連骨粗鬆症に特化した指針はなく，原発性骨粗鬆症に準じた治療方法で構わない。薬物治療の有効性を高めるためにも，十分なカルシウムとビタミンDの摂取を心がけるべきである。

　Nutritional guidance and exercise should be beneficial as well as pharmacotherapy in life style-related diseases including diabetes and osteoporosis. Sufficient and appropriate energy intake with protein, calcium and vitamin D is good for bone and muscles in osteoporotic patient. Diabetes patients are often recommended to reduce body weight. However, losing weight could be related to bone loss. Therefore, we should pay attention to keep balance between glucose metabolism and bone metabolism in the patients with both diseases. As for pharmacotherapy in osteoporosis with diabetes, there is so far no specific recommendation. Fall risk assessment and guidance should be emphasized in diabetes patient with osteoporosis, because they could have more fall risk due to diabetic complications such as neuropathy and retinopathy.