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Fracture prediction methods useful for type 2 diabetes

Schwartz AV. JAMA. 2011;305:2184-2192.

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Bone mineral density T-scores and WHO fracture risk algorithm scores appear useful for predicting fracture risk in older adults with type 2 diabetes. However, physicians should consider that type 2 diabetes may increase the risk associated with a given score.

“Preventive identification of adults at higher fracture risk is based on BMD T-scores, used alone or in the WHO fracture risk algorithm (FRAX) score,” researchers wrote in a study published in the Journal of the American Medical Association. “However, because type 2 [diabetes mellitus] is paradoxically associated with higher BMD and increased fracture risk, there is concern that these established methods for predicting fractures may not perform adequately in patients with type 2 [diabetes mellitus].”

To investigate this issue, researchers analyzed data from three prospective observational studies with fracture endpoints. Of 770 women with diabetes who participated in the studies, 84 experienced hip fractures and 262 nonspine fractures. For a 1-unit decrease in femoral neck BMD T-score, age-adjusted HRs were 1.88 (95% CI, 1.43-2.48) for hip fracture and 1.52 (95% CI, 1.21-1.75) for nonspine fracture. In addition, the HRs were 1.05 (95% CI, 1.03-1.07) for a 1-unit increase in FRAX hip fracture score and 1.04 (95% CI, 1.02-1.05) for a 1-unit increase in FRAX osteoporotic fracture score in women with diabetes.

Similarly, femoral neck BMD T-score and FRAX score were associated with fracture risk in men with diabetes. Of the 1,199 men with diabetes who participated in the study, 32 had hip fractures and 133 had nonspine fractures. Age-adjusted HRs for 1-unit decrease in femoral neck BMD T-score were 5.71 (95% CI, 3.42-9.53) for hip fracture and 2.17 (95% CI, 1.75-2.69) for nonspine fracture. Likewise, HRs were 1.16 (95% CI, 1.07-1.27) for a 1-unit increase in FRAX hip fracture score and 1.09 (95% CI, 1.04-1.14) for a 1-unit increase in FRAX osteoporotic fracture score.

Despite these methods’ utility in assessing fracture risk in this population, the researchers said “a given T-score or FRAX score is associated with a higher risk of fracture in older adults with [diabetes mellitus] compared with those without [diabetes mellitus]. Refinements are needed in current treatment and diagnostic algorithms for use in older patients with type 2 [diabetes mellitus].”

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