Answer A is incorrect: % chose this answer, “A 67-year-old female living with frequent falls and no bone fractures. She is newly diagnosed with type 2 diabetes, taking only metformin, with a bone density test 1 year ago that was normal.” This answer is incorrect. Per the 2026 ADA Standards of Care, she does meet criteria for assessing bone health due to her diagnosis of type 2 diabetes and risk factor of frequent falls, but she had a bone density test 1 year ago.  Currently, the recommendation is to re-evaluate the bone density test in 2-3 years.

Answer B is incorrect: % chose this answer, “A 49-year-old premenopausal woman with prediabetes who has a low vitamin D level but no history of bone fracture.” This answer is incorrect. Per the 2026 ADA Standards of Care, it is recommended to assess bone health in postmenopausal women with other diabetes specific risk factors. This risk factor does not include low vitamin D levels.

Answer C is correct: % chose this answer, “A 59-year-old male living with type 2 diabetes, taking pioglitazone, and whose A1c is 8.7%.” This answer is correct. Per the 2026 ADA Standards of Care, bone health should be assessed in men aged ≥50 years with type 2 diabetes and an A1c >8%. He is also on pioglitazone, a thiazolidinedione, which is another risk factor for low bone density.

Answer D is incorrect: % chose this answer, “A 43-year-old man living with type 2 diabetes for five years, taking metformin and an SGLT2 inhibitor, without diabetes related complications, but did break his arm as a child.” This answer is incorrect. Per the 2026 ADA Standards of Care, he has no diabetes-specific risk factors for bone loss. Diabetes duration is less than 10 years, he has no diabetes related complications such as peripheral or autonomic neuropathies, he is not on a high-risk medication for bone loss, and he has not had a bone fracture as an adult.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!