Diagnosis and management of bone fragility in diabetes: an emerging challenge

Fragility fractures are increasingly recognized as a complication of both type 1 and type 2 diabetes, with fracture risk that increases with disease duration and poor glycemic control. Yet the identification and management of fracture risk in these patients remains challenging. This review explores the clinical characteristics of bone fragility in adults with diabetes and highlights recent studies that have evaluated bone mineral density (BMD), bone microstructure and material properties, biochemical markers, and fracture prediction algorithms (i.e., FRAX) in these patients. It further reviews the impact of diabetes drugs on bone as well as the efficacy of osteoporosis treatments in this population. We finally propose an algorithm for the identification and management of diabetic patients at increased fracture risk

Access to Mutualistic Endosymbiotic Microbes: An Underappreciated Benefit of Group Living

The original publication is available at www.springerlink.com A central question in behavioral ecology has been why animals live in groups. Previous theories about the evolution of sociality focused on the potential benefits of decreased risk of predation, increased foraging or feeding efficiency, and mutual aid in defending resources and/or rearing offspring. This paper argues that access to mutualistic endosymbiotic microbes is an underappreciated benefit of group living and sets out to reinvigorate Troyer’s hypothesis that the need to obtain cellulolytic microbes from conspecifics influenced the evolution of social behavior in herbivores and to extend it to nonherbivores. This extension is necessary because the benefits of endosymbionts are not limited to nutrition; endosymbionts also help protect their hosts from pathogens. When hosts must obtain endosymbionts from conspecifics, they are forced to interact. Thus, complex forms of sociality may be more likely to evolve when hosts must repeatedly obtain endosymbionts from conspecifics than when endosymbionts can be obtained either directly from the environment, are vertically transmitted, or when repeated inoculations are not necessary. Observations from a variety of taxa are consistent with the ideas that individuals benefit from group living by gaining access to endosymbionts and the complexity of social behavior is associated with the mode of acquisition of endosymbionts. Ways to test this theory include (a) experiments designed to examine the effects of endosymbionts on host fitness and how endosymbionts are obtained and (b) using phylogenetic analyses to examine endosymbiont-host coevolution with the goal of determining the relationship between the mode of endosymbiont acquisition and host sociality