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Fracture prediction methods in older patients with type 2 diabetes mellitus


Use of established fracture prediction methods in older patients with type 2 diabetes mellitus found that scores from these methods were associated with hip and non-spine fracture risk, and a certain score associated with higher risk of fracture compared to persons without diabetes mellitus.

Because patients with type 2 diabetes mellitus often have higher levels of bone mineral density ( BMD ), it has been uncertain the applicability of fracture risk screening methods typically used for patients with lower levels of bone mineral density.

It is increasingly recognized that adults with type 2 diabetes mellitus, an estimated 17% of older adults in the United States, have a higher fracture rate. Preventive identification of adults at higher fracture risk is based on bone mineral density T scores, used alone or in the World Health Organization Fracture Risk Algorithm ( FRAX ) score. There is a need to clarify the use of standard methods for assessing fracture risk in this expanding population of older adults with type 2 diabetes mellitus.

Ann V. Schwartz, of the University of California, San Francisco and colleagues conducted a study to assess the associations of BMD T score and FRAX score with hip and non-spine fracture risk in older adults with type 2 diabetes mellitus.
The researchers analyzed data from 3 prospective observational studies with fracture outcomes that included 9,449 women and 7,436 men.

Of 770 women with diabetes mellitus, 84 experienced a hip fracture and 262 a non-spine fracture during an average follow-up of 12.6 years.
Of 1,199 men with diabetes mellitus, 32 experienced a hip fracture and 133 a non-spine fracture during an average follow-up of 7.5 years.

The researchers found that femoral neck BMD T score and FRAX score were associated with hip and non-spine fracture risk in patients with diabetes mellitus.

However, for a given T score and age, those adults with diabetes mellitus had a higher risk of fracture than those without diabetes mellitus, consistent with previous studies.

Participants with diabetes mellitus also experienced higher fracture rates at a given FRAX score than participants without diabetes mellitus.

The results have indicated that femoral neck BMD and the FRAX score are as useful for the assessment of fracture risk in older adults with diabetes mellitus as in those without diabetes.
However, interpretation of T score or FRAX score in an older patient with diabetes mellitus must take into account the higher fracture risk associated with diabetes. ( Xagena )

Source: JAMA, 2011

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