Bone ultrasound better predictor of fracture risk in patients with type 2 diabetes

Issue: July 2015

NASHVILLE, Tenn. - Bone ultrasound may provide better results than DXA when predicting osteoporotic fracture risk in patients with type 2 diabetes, according to study findings presented here.

Perspective from Susan E. Williams, MS, RD, MD, CCD, FACP, FACE

“DXA has given disappointing results in measuring the risk of fracture in patients with [type 2 diabetes],” the researchers wrote. “In the general population, bone ultrasound has demonstrated a predictive power of osteoporotic fracture equal to that of DXA. The aim of our study was to evaluate the risk of osteoporotic fracture by [bone ultrasound] of the calcaneal bone in patients with [type 2 diabetes].”

Franco Grimaldi, MD, president of the Italian chapter of the American Association of Clinical Endocrinologists, and colleagues at other institutions analyzed data from 108 consecutive patients with diabetes (55 men) and 287 healthy controls (102 men) matched for age and sex. Researchers performed bone ultrasound on the heel of participants, analyzing speed of sound, broadband ultrasound attenuation, stiffness index and the T-score.

Patients with diabetes showed lower T-scores than healthy controls (-0.56 ± 1.38 vs. -0.16 ± 1.18; P = .0004) and a higher BMI. All bone ultrasound parameters, including T-score, were lower for participants who had diabetes and fractures compared with patients with diabetes who did not have fractures (T-score: 1.73 ± 1.28 vs. 0.38 ± 1.31; P = .0001).

“Within the diabetic population, [bone ultrasound] values are significantly lower in subjects with fractures, compared to non-fractured,” the researchers wrote. “The ultrasound of the heel appears to be a promising method for screening for fracture risk in patients with [type 2 diabetes].” - by Regina Schaffer

Reference :

Grimaldi F, et al. Abstract 2139107. Presented at: AACE 24th Annual Scientific & Clinical Congress; May 13-17, 2015; Nashville, Tenn.

Disclosure: The researchers report no relevant financial disclosures.

Perspective

Susan E. Williams, MS, RD, MD, CCD, FACP, FACE

It has been well established in the literature that individuals with diabetes, although they typically have higher bone density, are at greater risk for fracture, and that DXA fails to accurately predict osteoporotic fracture risk in this patient population. DXA only measures bone density and cannot quantify bone quality, and it is bone quality that is really the issue here. There are several imaging modalities that can give us a look into the microarchitecture of the bone, but they are expensive, can involve higher levels of radiation exposure and are not readily available in clinical practice. Calcaneal ultrasound has been available for many years and was initially developed as a portable screening tool for osteoporosis in postmenopausal women over age 65. Grimaldi and colleagues used this technology to compare the bone density of patients with diabetes to that of healthy age-matched controls. What they found is that patients with diabetes had significantly lower T-scores when compared with healthy controls. Furthermore, T-scores were lower in patients with diabetes who had a history of fracture when compared with patients with diabetes who had not suffered a fracture. Of note, however, is the fact that the T-scores noted in the group with diabetes and history of fracture (T-score -1.73 +/-1.28), when compared with the WHO definitions, had bone mineral densities that ranged from “normal” to “osteoporotic.” In the study population with diabetes but no fractures, the T-score of -0.38 +/-1.31 ranged from “normal” to “osteopenic,” low bone mass. While it is clear to savvy clinicians that the presence of a fragility fracture warrants medical management, in those individuals with diabetes, without fracture and bone mineral density measurements in the normal range, accurate determination of fracture risk remains elusive.

Susan E. Williams, MS, RD, MD, CCD, FACP, FACE

Associate professor of medicine, department of endocrinology

Cleveland Clinic, Cleveland, OH

Disclosures: Williams reports no relevant financial disclosures.