Diabetes Increases Risk for Fractures, Screening Methods Inadequate

December 16, 2016

Authors of a recent study published in Calcified Tissue International & Musculoskeletal Research, caution physicians to be aware of increased fracture risk in patients with diabetes and of the limitations of standard methods of bone assessments in this population.

The prevalence of osteoporosis and diabetes, particularly type 2, is expected to increase as the world’s population ages and gets more obese. The heightened risk is seen with both type 1 and type 2 diabetes, according to G Isanne Schacter, MD, and William D Leslie, MD, from the University of Manitoba, Winnipeg (Manitoba, Canada).

Bone specialists have long known about the relationship between diabetes and fracture risk, but this is often overlooked by many primary care physicians and even some endocrinologists, Dr Leslie said.

Historically, doctors have tended to downplay the risk of osteoporosis among people with diabetes, especially type 2 diabetes, because these patients often are overweight, which usually is correlated with higher bone-mineral density (BMD), he explained.
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In their paper, Drs Schacter and Leslie reviewed several common skeletal parameters derived from dual X-ray absorptiometry (DXA) scanning to determine whether they could account for the excess fracture risk in people with type 1 and type 2 diabetes.

When possible, they recommended ways in which the parameters could be adjusted to provide a better estimate of a patient's risk.

They also studied the Fracture Risk Assessment Tool (FRAX), which is incorporated into modern DXA scanners. FRAX is already known to underestimate fracture risk in people with type 2 diabetes, due to their general higher body mass index as well as their risk of falling and subsequent changes in bone density.

Ultimately, they said, “diabetes is characterized by an increased fracture risk that is only partially explained by the BMD reductions seen in type 1 diabetes and is underestimated in type 2 diabetes where BMD is increased.”

“While BMD from DXA still stratifies fracture risk in those with diabetes, additional measures that can be obtained from DXA help to identify patients at increased risk of fracture. Incorporating this additional information into risk-prediction models may help to avoid systematically underestimating the risk of osteoporosis-related fractures in subjects with diabetes,” they conclude.—Amanda Del Signore