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Fracture risk based on BMD and FRAX score higher in adults with type 2 diabetes

Clinical Question:
Is a fracture risk based on bone mineral density and FRAX score as accurate in adults with type 2 diabetes as in otherwise healthy adults?

Bottom Line:
In older adults with type 2 diabetes, fracture risk is higher for a given bone mineral density (BMD) T score and age or for a given World Health Organization Fracture Risk Algorithm (FRAX) score compared with similar adults without type 2 diabetes. (LOE = 1b)

Schwartz AV, Vittinghoff E, Bauer DC, et al, for the Study of Osteoporotic Fractures (SOF) Research Group; Osteoporotic Fractures in Men (MrOS) Research Group; and Health, Aging, and Body Composition (Health ABC) Research Group. Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA 2011;305(21):2184-2192.  [PMID:21632482]

Study Design:
Cohort (prospective)

Industry + govt


Type 2 diabetes in adults is associated with higher BMD but an increased risk of osteoporotic fractures. These investigators pooled data from 3 prospective observational studies of older community-dwelling adults (9449 women and 7436 men) designed to identify risk factors for fracture. Diabetes diagnosis and drug therapy use was determined by self-report. Fracture confirmation occurred by central design using radiology report or radiographs. Femoral neck BMD T scores and FRAX scores were calculated using standard techniques. The FRAX score is an estimate of 10-year fracture risk based on age, BMD, and risk factors. Analyses were performed to estimate the effects of diabetes -- with and without insulin or other medication use -- on fracture risk. Follow-up occurred for a mean of 12.6 years. Femoral neck BMD T score was predictive of fracture in both men and women with and without diabetes. For a given T score, women and men with diabetes had a higher risk of hip or nonspine fracture than those without diabetes of similar age. This was was true for all women with diabetes, whether or not they were using insulin. However, men with diabetes who are not using insulin did not have an increased risk of nonspine fracture at a given BMD T score compared with men without diabetes. In both men and women with diabetes, the FRAX score underestimated the long-term risk of fracture. The authors performed a sensitivity analysis for other medications, including thiazolidinediones, and found no correlation with fracture risk.


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