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Da die Pr\u00e4valenz beider mit steigendem Alter zunimmt, wird in Anbetracht der Altersstruktur unserer Bev\u00f6lkerung deren H\u00e4ufigkeit zunehmen. Patienten mit Diabetes haben ein erh\u00f6htes Risiko f\u00fcr Fragilit\u00e4tsfrakturen. Die Pathophysiologie ist unklar und vermutlich multifaktoriell. Longitudinale Studien haben den Nachweis erbracht, dass das Fracture Risk Assessment Tool (FRAX) und die Knochendichte (BMD) mittels DXA-(T-Score)-Messungen und einem eventuell vorhandenen Trabecular Bone Score (TBS) das individuelle Frakturrisiko vorhersagen k\u00f6nnen. Hierf\u00fcr muss allerdings eine Adjustierung vorgenommen werden, um das Risiko nicht zu untersch\u00e4tzen. Es gibt derzeit aus osteologischer Sicht noch nicht den optimalen Ansatz, da es keine Studien mit rein diabetischen Patienten und Osteoporose gibt. Patienten mit Diabetes mellitus und einem erh\u00f6hten Frakturrisiko sollten genauso wie Patienten ohne Diabetes und einem erh\u00f6hten Frakturrisiko behandelt werden. Der Vitamin-D-Spiegel sollte auf jeden Fall immer optimiert werden, und auf eine ausreichende Kalziumaufnahme (vorzugsweise durch die Nahrung) ist zu achten. Bei der Wahl der antihyperglyk\u00e4mischen Therapie sollten Substanzen mit nachgewiesenem negativem Effekt auf den Knochen weggelassen werden. Bei Vorliegen einer Fragilit\u00e4tsfraktur ist auf jeden Fall \u2013\u00a0unabh\u00e4ngig von allen vorliegenden Befunden\u00a0\u2013 eine langfristige spezifische osteologische Therapie indiziert. Zur Pr\u00e4vention von Fragilit\u00e4tsfrakturen sind antiresorptive Medikamente die erste Wahl, entsprechend den nationalen Erstattungskriterien auch anabole Medikamente. Das Therapiemonitoring soll im Einklang mit der nationalen Osteoporose Leitlinie (Neufassung Herbst 2024) erfolgen.<\/jats:p>","DOI":"10.1007\/s00508-025-02664-x","type":"journal-article","created":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T22:14:49Z","timestamp":1779315289000},"page":"404-415","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Diagnose und Management der Osteoporose bei Diabetes mellitus (Update 2026)","Diagnosis and management of diabetes and co-existing osteoporosis (Update 2026)"],"prefix":"10.1007","volume":"138","author":[{"given":"Christian","family":"Muschitz","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Kautzky-Willer","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martina","family":"Rauner","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yvonne","family":"Winh\u00f6fer-St\u00f6ckl","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith","family":"Haschka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,30]]},"reference":[{"issue":"9","key":"2664_CR1","doi-asserted-by":"publisher","first-page":"1134","DOI":"10.1111\/dme.12734","volume":"32","author":"VN Shah","year":"2015","unstructured":"Shah\u00a0VN, Shah\u00a0CS, Snell-Bergeon\u00a0JK. 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