Evaluating soil acidification risk and its effects on biodiversity–ecosystem multifunctionality relationships in the drylands of China

Background:Soil acidifcationn caused by anthropogenic activities may aft soil biochemical cydling,bidiversity,productivity,and multiple eosystem-related functions in drylands.However,to date,such information is lacking to support this hypothesis.Methods Based on a transect survey of 78 naturally assembled shrub communities,we caloulated acid deposition flux in Northwest China and evaluated its likely ecological ffets by testing three altemnative hypotheses,namely:.nidche complementarity,mass ratio,and vegetation quantity hypotheses Rao's quadratic entopy and community-weighted mean traits were employed to represent the complementary aspect of niche complementarity and mass ratio effects,respectively.Resulbs:We observed that in the past four decades,the concentrations of exchangeable base cations in soil in Northwest China have decreased significantly to the extent of having faced the risk of depletion,whereas changes in the calium carbonate content and pH of soil were not significant.Adid deposition primani ly increased the aboweground biomass and shrub density in shrublands but had no sigmificant effect on shrub richness and ecasystem multifunctionality(EMF),indicating that acid deposition had positive but weak ecological effects on dryland ecosystems.Community wd ghted mean of functional traits(representing the mass ratio hypothesis)correlated negatively with EMF,whereas both Rao's quadratic entropy(representing the niche complementarity hypothesis)and aboveground biomass(representing the vegetation quantity hypothesis)correlated positively but insignifcantly with EMF.These biodiversity-EMF relationships highlight the fragility and instability of drylands relative to forest ecasystems.Concuions:The findings from this study serve as important reference points to understand the ris of soil acidification in arid regions and its impacts on biodiversity-EMF relationships.

Elevated cardiovascular risk and acute events in hospitalized colon cancer survivors:A decade-apart study of two nationwide cohorts

BACKGROUND Over the years,strides in colon cancer detection and treatment have boosted survival rates;yet,post-colon cancer survival entails cardiovascular disease(CVD)risks.Research on CVD risks and acute cardiovascular events in colorectal cancer survivors has been limited.AIM To compare the CVD risk and adverse cardiovascular outcomes in current colon cancer survivors compared to a decade ago.METHODS We analyzed 2007 and 2017 hospitalization data from the National Inpatient Sample,studying two colon cancer survivor groups for CVD risk factors,mortality rates,and major adverse events like pulmonary embolism,arrhythmia,cardiac arrest,and stroke,adjusting for confounders via multivariable regression analysis.RESULTS Of total colon cancer survivors hospitalized in 2007(n=177542)and 2017(n=178325),the 2017 cohort often consisted of younger(76 vs 77 years),male,African-American,and Hispanic patients admitted non-electively vs the 2007 cohort.Furthermore,the 2017 cohort had higher rates of smoking,alcohol abuse,drug abuse,coagulopathy,liver disease,weight loss,and renal failure.Patients in the 2017 cohort also had higher rates of cardiovascular comorbidities,including hypertension,hyperlipidemia,diabetes,obesity,peripheral vascular disease,congestive heart failure,and at least one traditional CVD(P<0.001)vs the 2007 cohort.On adjusted multivariable analysis,the 2017 cohort had a significantly higher risk of pulmonary embolism(PE)(OR:1.47,95%CI:1.37-1.48),arrhythmia(OR:1.41,95%CI:1.38-1.43),atrial fibrillation/flutter(OR:1.61,95%CI:1.58-1.64),cardiac arrest including ventricular tachyarrhythmia(OR:1.63,95%CI:1.46-1.82),and stroke(OR:1.28,95%CI:1.22-1.34)with comparable all-cause mortality and fewer routine discharges(48.4%vs 55.0%)(P<0.001)vs the 2007 cohort.CONCLUSION Colon cancer survivors hospitalized 10 years apart in the United States showed an increased CVD risk with an increased risk of acute cardiovascular events(stroke 28%,PE 47%,arrhythmia 41%,and cardiac arrest 63%).It is vital to regularly screen colon cancer survivors with concomitant CVD risk factors to curtail long-term cardiovascular complications.

Updates on global epidemiology,risk and prognostic factors of gastric cancer

Gastric cancer(GC)is defined as the primary epithelial malignancy derived from the stomach,and it is a complicated and heterogeneous disease with multiple risk factors.Despite its overall declining trend of incidence and mortality in various countries over the past few decades,GC remains the fifth most common malignancy and the fourth leading cause of cancer-related death globally.Although the global burden of GC has shown a significant downward trend,it remains severe in certain areas,such as Asia.GC ranks third in incidence and mortality among all cancer types in China,and it accounts for nearly 44.0%and 48.6%of new GC cases and GC-related deaths in the world,respectively.The regional differences in GC incidence and mortality are obvious,and annual new cases and deaths are increasing rapidly in some developing regions.Therefore,early preventive and screening strategies for GC are urgently needed.The clinical efficacies of conventional treatments for GC are limited,and the developing understanding of GC pathogenesis has increased the demand for new therapeutic regimens,including immune checkpoint inhibitors,cell immunotherapy and cancer vaccines.The present review describes the epidemiology of GC worldwide,especially in China,summarizes its risk and prognostic factors,and focuses on novel immunotherapies to develop therapeutic strategies for the management of GC patients.

Narrative minireview of the spatial epidemiology of substance use disorder in the United States:Who is at risk and where?

Drug overdose is the leading cause of death by injury in the United States.The incidence of substance use disorder(SUD)in the United States has increased steadily over the past two decades,becoming a major public health problem for the country.The drivers of the SUD epidemic in the United States have changed over time,characterized by an initial heroin outbreak between 1970 and 1999,followed by a painkiller outbreak,and finally by an ongoing synthetic opioid outbreak.The nature and sources of these abused substances reveal striking differences in the socioeconomic and behavioral factors that shape the drug epidemic.Moreover,the geospatial distribution of the SUD epidemic is not homogeneous.The United States has specific locations where vulnerable communities at high risk of SUD are concentrated,reaffirming the multifactorial socioeconomic nature of this epidemic.A better understanding of the SUD epidemic under a spatial epidemiology framework is necessary to determine the factors that have shaped its spread and how these patterns can be used to predict new outbreaks and create effective mitigation policies.This narrative minireview summarizes the current records of the spatial distribution of the SUD epidemic in the United States across different periods,revealing some spatiotemporal patterns that have preceded the occurrence of outbreaks.By analyzing the epidemic of SUD-related deaths,we also describe the epidemic behavior in areas with high incidence of cases.Finally,we describe public health interventions that can be effective for demographic groups,and we discuss future challenges in the study and control of the SUD epidemic in the country.

Extension of Goal-Directed Behavior Model for Post-Pandemic Korean Travel Intentions to Alternative Local Destinations: Perceived Risk and Knowledge

Since the outbreak of COVID-19,tourists have been increasingly concerned over various risks of international travel,while knowledge of the pandemic appears to vary significantly.In addition,as travel restrictions continue to impact adversely on international tourism,tourism efforts should be placed more on the domestic markets.Via structural equation modeling,this study unearthed different risk factors impacting Korean travelers’choices of alternative local destinations in the post-pandemic era.In addition,this study extended the goal-directed behavior framework with the acquisition of perceived risk and knowledge of COVID-19,which was proven to hold a sig-nificantly superior explanatory power of tourists’decisions of local alternatives over foreign countries during the COVID-19 pandemic.Furthermore,desire was found to play an imminent mediating role in the conceptual mod-el,maximizing the impact of perceived risk on travel intentions.Henceforth,this research offers meaningful the-oretical implication as thefirst empirical study to deepen the goal-directed behaviour framework with perceived risk and knowledge in the context of post-COVID-19 era.It also serves as insightful knowledge for Korean tour-ism authorities and practitioners to understand local tourists’decision-making processes and tailor effective recovery strategy for domestic tourism.

Risk and predictors of severity and mortality in patients with type 2 diabetes and COVID-19 in Dubai

BACKGROUND Globally,patients with diabetes suffer from increased disease severity and mortality due to coronavirus disease 2019(COVID-19).Old age,high body mass index(BMI),comorbidities,and complications of diabetes are recognized as major risk factors for infection severity and mortality.AIM To investigate the risk and predictors of higher severity and mortality among inhospital patients with COVID-19 and type 2 diabetes(T2D)during the first wave of the pandemic in Dubai(March–September 2020).METHODS In this cross-sectional nested case-control study,a total of 1083 patients with COVID-19 were recruited.This study included 890 men and 193 women.Of these,427 had T2D and 656 were non-diabetic.The clinical,radiographic,and laboratory data of the patients with and without T2D were compared.Independent predictors of mortality in COVID-19 non-survivors were identified in patients with and without T2D.RESULTS T2D patients with COVID-19 were older and had higher BMI than those without T2D.They had higher rates of comorbidities such as hypertension,ischemic heart disease,heart failure,and more life-threatening complications.All laboratory parameters of disease severity were significantly higher than in those without T2D.Therefore,these patients had a longer hospital stay and a significantly higher mortality rate.They died from COVID-19 at a rate three times higher than patients without.Most laboratory and radiographic severity indices in non-survivors were high in patients with and without T2D.In the univariate analysis of the predictors of mortality among all COVID-19 non-survivors,significant associations were identified with old age,increased white blood cell count,lymphopenia,and elevated serum troponin levels.In multivariate analysis,only lymphopenia was identified as an independent predictor of mortality among T2D non-survivors.CONCLUSION Patients with COVID-19 and T2D were older with higher BMI,more comorbidities,higher disease severity indices,more severe proinflammatory state with cardiac involvement,and died from COVID-19 at three times the rate of patients without T2D.The identified mortality predictors will help healthcare workers prioritize the management of patients with COVID-19.

Sources of Farm Risk and Management Strategies among Cowpea(Vigna unguiculata SSP)Producers in North East Nigeria

The study identified sources of farm risks and management strategies used among cowpea producers in North East,Nigeria.Data were collected using structured questionnaires from 595 cowpea producers.Multi-stage sampling procedure was used to select cowpea producers for the study.In the first stage purposive sampling was used to select three(3)states from the six(6)states in the region and these states include Adamawa,Bauchi and Gombe States.From these selected states two(2)local governments each were selected based on apriory information on cowpea production from the state Agricultural Development Programs(ADPs)and analysed using descriptive statistics,Likert scale and multiple regression model.The result revealed that,pest and diseases emerged as the common source of production risk at 74%.Also,uncertainty from product price 66%was a major source of marketing risk.Furthermore,inadequate credit was an important financial risk at 54%and lack of cooperative 51%were major sources of both financial and institutional risks.The valid management strategies used in mitigating/coping among cowpea producers were livestock production to complement income,sales of produce,engagement in other jobs/activities,access to ADP’s extension agent among others.Therefore,cowpea production is affected by production/environmental risk,marketing risk,financial risk,institutional risk and human/personnel risk and exhibited risk aversion attitude.The study recommends strategy of developing early varieties,disease resistant crops and products that are resistant to pest both in the farm and storage to raise the productivity of cowpea.Also,cowpea producers’cooperatives should be strengthened with priority given enlightened/educating members,create strong bargaining power for farm products as well as accessing credit facilities.Similarly,inputs such as fertilizers and certified improved high-quality seeds are available and accessible to cowpea producers to increase production and reduce risks.

Biopsychosocial impact of discrimination on cancer risk and outcome: A conceptual review

Discrimination,a major social factor influencing health,can influence both the risk and course of cancer.The medical and psychological mechanisms through which discrimination can impact the onset and spread of cancer are explored in depth in this conceptual evaluation.In addition to investigating the ethical aspects of discrimination in cancer research,it also studies the effects of bias on cancer detection and therapy.In addition,this review provides suggestions for reducing the effect of discrimination on cancer risk and outcomes.Discrimination,in particular,can trigger the growth and spread of cancer via various pathways,including stress,inflammation,and changes in epigenetic patterns.It can also affect the immune system,making the body more vulnerable to the proliferation of cancerous cells.Discrimination can result in hindrances or delays in the process of cancer screening and treatment,and it can influence the quality of care for individuals suffering from cancer.This can contribute to the presence of disparities in terms of cancer vulnerability,occurrence,mortality,and survival rates among different demographic groups.Various measures can be implemented to mitigate the impact of discrimination on cancer vulnerability and outcomes.These measures address the underlying causes of discrimination,ensure that all individuals have access to exceptional cancer care,promote the acquisition of cultural proficiency and anti-bias training by healthcare providers,and develop and implement interventions to reduce discrimination’s impact on cancer vulnerability,screening,and treatment.

Ratio K: a New Way of Metering and Evaluating the Risk and Return of Stock Investment

Although widely used, both the Markowitz model and VAR (Value at Risk) model have some limitations in evaluating the risk and return of stock investment. By the analysis of the conceptions of risk and return, together with the three hypotheses of technological analysis, a novelty model of metering and evaluating the risk and return of stock investment is established. The major indicator of this model , risk-return ratio K, combines the characteristic indicators of risk and return. Regardless of the form of the risk-return probability density functions, this indicator K can always reflect the risk-return performances of the invested stocks clearly and accurately. How to use the model to make optimum investment and how to make portfolio combined with clustering analysis is also explained.

Competence Set Analysis Under Risk and Uncertainty

The competence set analysis technology can be applied to solve the decision making problems successfully and satisfactorily. This paper mainly focuses on the expanding strategy research and development of the competence set under risk and uncertainty. A systematic expression of the competence set analysis is described, several expanding principles and strategies with regard to several different cases are presented, and their applications in the personnel training program are discussed, some conclusions and suggestions to be developed in a further work are included.

Evaluation of ecological risk and primary empirical research on heavy metals in polluted soil over Xiaoqinling gold mining region,Shaanxi,China

Soil,crop and residents'hair over Xiaoqinling gold mining region,China,which was selected as a case study,were sampled and analyzed for Hg,Cd,Pb,Cu,Cr,As and Zn concentrations.The concentrations of heavy metals in soil or crop and hair samples were used to assess their potential ecological risks,or to find the responses to these metals as evidences to prove the potential risk was coming down to observed harm,respectively.The results showed that,these metals in soil were ranked by severity of ecological risk as Hg>Cd>Pb>Cu>Cr>As>Zn,based on their single-element indexes.In the view of the potential ecological risk indexes,of all soil samples,about half had significantly high or high potential ecological risk,which covered more than 74%of the studied region.Most of the risks were 97.41%from Hg,Pb and Cd,especially,84.37%from Hg.Both the single-element and potential ecological risk indexes indicated that,the ecological risk grades had a special spatial characteristic,and increased from northwest to southeast generally.This was agreed with the spatial distribution of the strength in gold mining activities over the studied region.The concentrations of Hg and Pb were higher than their relative backgrounds in the corps,and were even 9.48 and 25.09 times higher than their relative backgrounds in residents'hair,respectively.All these showed that the heavy metals in the soil had a high potential ecological risk,especially,had been affecting these crops'growing and yield,and even the residents'health through food strains.Obviously,these metals'potential ecological harm had been coming down to observed harm to the ecology.

Climate Change, Risk and Grain Yields in China

Adopting Just and Pope （1978, 1979） style yield functions, this paper proposes a method to analyze the impacts of regional climate change on grain production in China. We find that changes in climate will affect grain production in North and South China differently. Specifically, it emerges that a 1℃ increase in annual average temperature could reduce national grain output by 1.45% （1.74% reduction in North China and 1.19% reduction in South China）, while an increase in total annual precipitation of around 100 mm could increase national grain output by 1.31% （3.0% increase in North China and 0.59% reduction in South China）.

Association of twelve polymorphisms in three onco-lncRNA genes with hepatocellular cancer risk and prognosis:A case-control study

AIM To evaluate the association of 12 tag single nucleotide polymorphisms(tag SNPs) in three onco-long non-coding RNA(lnc RNA) genes(HOTTIP,CCAT2,MALAT1) with the risk and prognosis of hepatocellular cancer(HCC). METHODS Twelve tag SNPs covering the three onco-lnc RNAs were genotyped by the KASP method in a total of 1338 samples,including 521 HCC patients and frequencymatched 817 controls. The samples were obtained from an unrelated Chinese population at the First Hospital ofChina Medical University from 2012-2015. The expression quantitative trait loci(e QTL) analyses were conducted to explore further the potential function of the promising SNPs. RESULTS Three SNPs in HOTTIP,one promoter SNP in MALAT1,and one haplotype of HOTTIP were associated with HCC risk. The HOTTIP rs17501292,rs2067087,and rs17427960 SNPs were increased to 1.55-,1.20-,and 1.18-fold HCC risk under allelic models(P = 0.012,0.017 and 0.049,respectively). MALAT1 rs4102217 SNP was increased to a 1.32-fold HCC risk under dominant models(P = 0.028). In addition,the two-way interaction of HOTTIP rs17501292-MALAT1 rs619586 polymorphisms showed a decreased effect on HCC risk(P interaction = 0.028,OR = 0.30) and epistasis with each other. HOTTIP rs3807598 variant genotype showed significantly longer survival time in HBV negative subgroup(P = 0.049,HR = 0.12),and MALAT1 rs591291 showed significantly better prognosis in female and HBV negative subgroups(P = 0.022,HR = 0.37; P = 0.042,HR = 0.25,respectively). In the study,no significant effect was observed in e QTL analysis. CONCLUSION Specific lnc RNA(HOTTIP and MALAT1) SNPs have potential to be biomarkers for HCC risk and prognosis.

Prediction of petroleum exploration risk and subterranean spatial distribution of hydrocarbon accumulations

Investigation of spatial distribution of oil and gas resource and accurate prediction of the geographic location of its undiscovered resource is significant for reducing exploration risk and improving exploration benefit.A new method for predicting spatial distribution of oil resource is discussed in this paper.It consists of prediction of risk probability in petroleum exploration and simulation of hydrocarbon abundance. Exploration risk probability is predicted by multivariate statistics,fuzzy mathematics and information processing techniques.A spatial attribute database for sample wells was set up and the Mahalanobis distance and Fuzzy value of given samples were obtained.Then,the Bayesian formula was used to calculate the hydrocarbon-bearing probability at the area of exploration wells.Finally,a hydrocarbon probability template is formed and used to forecast the probability of the unknown area. The hydrocarbon abundance is simulated based on Fourier integrals,frequency spectrum synthesis and fractal theory.Firstly,the fast Fourier transformation（FFT） is used to transform the known hydrocarbon abundance from the spatial domain to the frequency domain,then,frequency spectrum synthesis is used to produce the fractal frequency spectrum,and FFT is applied to get the phase information of hydrocarbon-bearing probability.Finally,the frequency spectrum simulation is used to calculate the renewed hydrocarbon abundance in the play. This method is used to predict the abundance and possible locations of the undiscovered petroleum accumulations in the Nanpu Sag of the Bohai Bay Basin,China.The prediction results for the well-explored onshore area of the northern Nanpu Sag agree well with the actual situations.For the less-explored offshore areas in the southern Nanpu Sag,the prediction results suggest high hydrocarbon abundance in Nanpu-1 and Nanpu-2,providing a useful guiding for future exploration.

Engineering models for catastrophe risk and their application to insurance

Internationally earthquake insurance,like all other insurance (fire,auto),adopted actuarial approach in the past, which is,based on historical loss experience to determine insurance rate.Due to the fact that earthquake is a rare event with severe consequence,irrational determination of premium rate and lack of understanding scale of potential loss led to many insurance companies insolvent after Northridge earthquake in 1994. Along with recent advances in earth science,computer science and engineering,computerized loss estimation methodologies based on first principles have been developed to the point that losses from destructive earthquakes can be quantified with reasonable accuracy using scientific modeling techniques. This paper intends to introduce how engineering models can assist to quantify earthquake risk and how insurance industry can use this information to manage their risk in the United States and abroad.

Polymorphisms of ICAM-1 are associated with gastric cancer risk and prognosis

AIM:To investigate the association between single nu-cleotide polymorphisms (SNPs) in intercellular adhesion molecule-1 (ICAM-1) and the risk,biological behavior and prognosis of gastric cancer (GC) in Chinese population.METHODS:The study group consisted of 332 GC patients and 380 healthy controls.Genotyping was performed using polymerase chain reaction and the results were confirmed by sequencing.The associa-tion of ICAM-1 K469E polymorphisms and the risk of GC were studied,and the correlation of ICAM-1 K469E polymorphisms with the clinicopathological parameters and prognosis of the patients with complete clinical and follow-up data was analyzed.RESULTS:Carriers of AA genotype had a significantly increased risk of GC compared with carriers of AG and GG genotypes [odds ratios:1.36;95% confidence in-terval (CI):1.01-1.84;P=0.041].GC patients with AA genotype were more prone to distant metastasis than those carrying AG and GG genotypes (18.9% vs 7.0%,respectively;P=0.002).In addition,patients at stage Ⅳ had significantly more carriers of AA genotype than those of AG and GG genotype (27.4% vs 16.9%,re-spectively;P=0.046).Follow-up study showed that the overall cumulative survival rate was 23.7% in AA geno-type group and 42.9% in AG and GG genotypes group.In univariate analysis,AA genotype was correlated with the overall cumulative survival (P=0.034).But in multi-variate analysis,ICAM-1 polymorphism was not an inde-pendent prognostic factor for the overall survival (relative risk,1.145;95% CI:0.851-1.540;P=0.370).CONCLUSION:Polymorphisms of ICAM-1 K469E can be a useful biomarker for identifying individuals with higher risk of GC,predicting disease progression,and guiding individualized treatment.

Prostate cancer risk and aggressiveness associated with the CYPIB1 4326C/G （Leu432Val） polymorphism： a meta-analysis of 2788 cases and 2968 controls

To derive a precise estimation of the associations between the cytochrome P450 1B 1 （CYPIB1） 4326C/G variants and prostate cancer （PCa） risk or aggressiveness, a meta-analysis was performed using all eligible published studies. Odds ratios （ORs） with 95% confidence intervals （CIs） were estimated to assess the association in seven literature studies with 2788 cases and 2968 controls. In the overall analysis, no significant association was found between the CYPIB1 4326C/G polymorphism and PCa risk, but ethnicity subgroup analyses and a case-source analysis revealed significant associations. The 4326G allele showed a significant association with increased PCa risk in Asians （OR= 1.52, 95% Ch 1.20-1.92）, and significant associations were also observed in a heterozygote comparison （OR= 1.40, 95% Ch 1.03-1.89）, a homozygote comparison （0R=2.38, 95% Ch 1.31-4.33） and in a dominant genetic model （OR = 1.52, 95% Ch 1.14-2.01）. Moreover, the 4326G allele was also significantly correlated with an increased risk of sporadic PCa （OR= 1.13, 95% Ch 1.04-1.24）, and significant associations were observed in a heterozygote comparison （OR= 1.16, 95% Ch 1.02-1.33）, a homozygote comparison （OR= 1.24, 95% Ch 1.03-1.49） and a dominant genetic model （OR= 1.19, 95% Ch 1.05- 1.34）. The overall analyses and all subgroup analyses showed no significant association between the 4326C/G polymorphism and PCa aggressiveness. Our meta-analysis showed that CYPIB1 4326G allele is significantly associated with an increased PCa risk in Asians and in sporadic PCa cases.

Study on Environmental Risk and Economic Benefits of Rotation Systems in Farmland of Erhai Lake Basin

This study was designed to find out an optimised planting system of reducing non-point （source） pollution by analyzing the reasons and the factors of influence non-point pollution in farmland of Erhai Lake basin. The results showed that incomes, residual nitrogen in soil, and the loss of nitrogen in surface water in rice-garlic system were higher than those in rice-fava bean system. There were positive correlations between the nitrogen loss of farmland, nitrogen inputs, residual nitrogen in soil, and incomes of farmland. Economic benefits and environment benefits are both appropriate, if the area of rice-garlic system would be reduced to 53% and the area of rice-fava bean system increased to 36% of total cropping area in the investigated watershed. Adjustment of planting structure and introduction of reasonable rotation systems is considered an effective measure of controlling agricultural non-point pollution in watersheds of Erhai Lake.

Critical review of bone health,fracture risk and management of bone fragility in diabetes mellitus

The risk of fracture is increased in both type 1 diabetes mellitus(T1DM)and type 2 diabetes mellitus(T2DM).However,in contrast to the former,patients with T2DM usually possess higher bone mineral density.Thus,there is a considerable difference in the pathophysiological basis of poor bone health between the two types of diabetes.Impaired bone strength due to poor bone microarchitecture and low bone turnover along with increased risk of fall are among the major factors behind elevated fracture risk.Moreover,some antidiabetic medications further enhance the fragility of the bone.On the other hand,antiosteoporosis medications can affect the glucose homeostasis in these patients.It is also difficult to predict the fracture risk in these patients because conventional tools such as bone mineral density and Fracture Risk Assessment Tool score assessment can underestimate the risk.Evidence-based recommendations for risk evaluation and management of poor bone health in diabetes are sparse in the literature.With the advancement in imaging technology,newer modalities are available to evaluate the bone quality and risk assessment in patients with diabetes.The purpose of this review is to explore the patho-physiology behind poor bone health in diabetic patients.Approach to the fracture risk evaluation in both T1DM and T2DM as well as the pragmatic use and efficacy of the available treatment options have been discussed in depth.