Fracture and mortality outcomes by osteoporosis treatment route in patients with type 2 diabetes and obesity: a propensity-matched registry study

In this real-world cohort of patients with type 2 diabetes and obesity, osteoporosis treatment was associated with improved survival but not reduced fracture risk. Injectable therapies offered greater fracture protection but were linked to higher mortality, likely due to confounding by indication. Poor adherence may limit the effectiveness of oral treatments in routine care. These findings underscore the need for individualized osteoporosis management strategies in high-risk diabetic populations and raise important considerations regarding the optimal route of administration in real-world settings.