The prevalence of pre-existing diabetes mellitus in pregnancy (DIP) is about 1% and gestational diabetes (GDM) at 8-30% of pregnancies in Australia. 1,2 DIP and to a lesser extent, GDM are well-known risk factors implicated in a variety of maternal and obstetric complications, including stillbirth and neonatal deaths. The management of diabetes before and during pregnancy is critical in minimising the risk of such complications. The risks of a diabetic pregnancy to a fetus are numerous and include stillbirth, intra-uterine growth restriction (IUGR), large for gestational age (LGA) and macrosomia with associated traumatic birth injuries, congenital abnormalities, intrapartum hypoxia-ischaemia, electrolyte and metabolic abnormalities, and

Bisphosphonates (BPs) are commonly used in the treatment of osteoporosis and are effective in the prevention of fragility fracture. Long‐term use has been associated with the development of atypical femur fractures (AFFs) and osteonecrosis of the jaw (ONJ). Drug holidays seek to reduce the risk of insufficiency fractures (AFFs) while maintaining durable effects of long‐term treatment in the prevention of fragility fracture. Guidelines suggest that BP drug holidays be considered after 3 to 5 years. However individual factors impacting this decision and outcomes are unclear. This review examines key factors in the planning of a safe BP drug holiday and surrogate markers of fracture risk in patients discontinuing treatment. Fifteen randomized control trials and 19 real‐world studies were included, including nationwide prospective studies from several countries. Increases in bone turnover markers (BTMs) and reductions in bone mineral density (BMD) were generally observed during BP drug holidays. Resurgent bone turnover was problematic in high‐risk patients in whom fractures recurred as early as 12 months following a drug holiday. Risk factors for holiday‐related fractures included older age, low hip BMD, underweight, low medication adherence, and prevalent/incident fractures. Zoledronic acid conferred the most durable reduction in fractures, particularly after six annual infusions. Five years of alendronate was insufficient in preventing vertebral fractures in high‐risk patients embarking on a drug holiday. Relatively faster offset of antiresorptive effect was seen in risedronate users with more frequent fractures than alendronate during a drug holiday. Studies directly counterbalancing effects of long‐term treatment on AFF risk versus drug holiday outcomes in the same population were lacking. In the absence of persistently high fracture risk and following a specific treatment duration dependent on the BP used, drug holidays are safe and mitigate the risk of AFF. However, anti‐resorptive effects diminish over time; ongoing monitoring and careful planning of BP resumption is necessary. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

BackgroundGlycated haemoglobin, or HbA1c, is the main biomarker used to assess long-term glycaemic control in individuals with diabetes, and it correlates with the development of complications.HbA1c: More than just a number Focus | Clinical

No abstract