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MrOS: Vertebral fracture rates comparable in people with, without diabetes
The prevalence and incidence of vertebral fractures do not appear to be higher in adults with type 2 diabetes than in adults without diabetes; however, greater spine areal bone mineral density may be associated with a lower risk among both groups, study data show.
Nicola Napoli, MD, PhD, of the unit of endocrinology and diabetes, department of medicine at the Universitá Campus Bio-Medico di Roma in Italy, and colleagues evaluated data from the Osteoporotic Fractures in Men study (MrOS) on 5,554 men (mean age, 73.6 years) with (n = 875) or without type 2 diabetes to determine whether the prevalence and incidence of vertebral fractures are higher in those with diabetes. Two percent of participants without diabetes and 2.2% with diabetes were prescribed anti-osteoporosis treatment.
Overall, 7% of participants with diabetes and 7.7% without diabetes had prevalent vertebral fractures, and 4.4% of participants with diabetes and 4.5% without diabetes had incident vertebral fractures.
The estimated association between diabetes and vertebral fractures increased after adjustment for areal BMD (OR = 1.05; 95% CI, 0.78-1.4) and volumetric BMD (OR = 1.3; 95% CI, 0.89-1.88); however, the increases did not reach statistical significance. No difference was found between the two groups for risk for incident vertebral fractures.
A lower risk for prevalent vertebral fracture was associated with higher spine areal BMD in participants with diabetes (OR = 0.55; 95% CI, 0.48-0.63) and without diabetes (OR = 0.66; 95% CI, 0.5-0.88); the risk for incident vertebral fracture was also lower with higher spine areal BMD in diabetes (OR = 0.5; 95% CI, 0.41-0.6) and no diabetes (OR = 0.54; 95% CI, 0.33-0.88). Similar results were observed for volumetric BMD. – by Amber Cox
Disclosures: The researchers report no relevant financial disclosures.
Perspective
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Vertebral compression fractures are a major manifestation of osteoporosis, but usually do not produce sufficient symptomatology at the time of the event to bring patients to the attention of a health care provider. In the Napoli study, rates of prevalent and incident vertebral fractures diagnosed by radiographic imaging were compared between men with and without diabetes, 65 years and older, from the MrOS study. Having type 2 diabetes did not significantly increase the risk of either prevalent or incident radiographic fractures even after controlling for age, BMD and BMI. Of course, lower spine BMD was a significant predictor of risk for vertebral fracture in men with and without diabetes. It is possible that the effects of diabetes are more apparent in skeletal regions comprised of higher cortical bone content (long bones and hip) vs higher cancellous bone content. Regardless of the lack of difference between those with and without diabetes, clearly undiagnosed prevalent vertebral fracture is a major public health concern. These fractures are associated with substantial morbidity and mortality and are a clear sign of skeletal fragility and increased future fracture risk. Men in this study had a prevalence of 7% to 8% and an incident risk of about 1% annually. The only way we will find individuals with these fractures, and target them for appropriate pharmacotherapy, is with targeted screening vertebral imaging, as proposed by the National Osteoporosis Foundation, American Association for Clinical Endocrinologists and International Society for Clinical Densitometry.