Peculiarities of treatment and prevention in patients with type 2 diabetes mellitus with osteoporotic disorders in a region with a high birth rate

Aim. To review the experience of managing patients with type 2 diabetes mellitus complicated by osteoporotic changes in a region with a high birth rate.

Materials and methods. We observed 110 patients with type 2 diabetes - 55 women with a normal parity, 55 women with a high parity in history. The control group consisted of 55 women of the same age who did not suffer from type 2 diabetes. The parameters of lipid, phosphorus-calcium metabolism, vitamin D, and markers of bone remodeling were studied. The method of dual-energy X-ray absorptiometry with an osteodensitometer was used to assess the possible loss of bone tissue.

Results. The choice of treatment tactics for patients with type 2 diabetes was based on the baseline level of glycated hemoglobin (HbA1c) and main clinical symptoms. When the level of glycated hemoglobin was more than 7% (7.5-8.0), metformin monotherapy was prescribed. At initially high levels of HbA1c (8-9%), a combination of antihyperglycemic drugs was prescribed (glipizide in combination with metformin; DPP-4-alogliptin inhibitor with metformin). In the group of patients with baseline HbA1c levels (9-9.5%), therapy with GLP-1 (liraglutide) was carried out. Over the past year, a new antihyperglycemic drug from the group and NGLT-2 (dapagliflozin) was tested. Its mechanism is based on a decrease in the reabsorption of glucose in kidneys. Stable preservation of the reduced HbA1c was noted against the background of combined use with metformin. Following osteoporotic drugs were used: Zolendronic acid (Aklasta), denosumab, teriparatide.

Conclusion. An individual treatment approach to patients with type 2 diabetes complicated by osteoporotic disorders through the combined use of hypoglycemic and osteotropic medicines gave a positive result. Prevention of osteoporotic changes in patients with type 2 diabetes of the postmenopausal period should be comprehensive, taking into account the maintenance of the glycemic level under the control of the HbA1c content ≤ 7%, the fight against complications of diabetes mellitus, the inclusion of regular dosed physical exercises and additional measures taking into account the multiple births factor.

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