Bone Turnover Markers Do Not Predict Fracture Risk in Type 2 Diabetes
Nicola Napoli1,2, Caterina Conte3, Richard Eastell4
1Division of Endocrinology and Diabetes, University Campus Bio-Medico di Roma, Rome, Italy.
Summary
Bone turnover markers do not predict fractures in type 2 diabetes (T2D). However, these markers were associated with increased fracture risk in individuals without diabetes, suggesting different fracture prediction pathways.
Area of Science:
- Endocrinology
- Gerontology
- Orthopedics
Background:
- Type 2 diabetes (T2D) is linked to higher fracture risk despite normal or high bone mineral density (BMD).
- BMD may underestimate fracture risk in T2D.
- The predictive value of bone turnover markers (BTMs) for fractures in T2D remains underexplored.
Purpose of the Study:
- To investigate whether BTMs predict incident fractures in older adults with T2D.
- To compare the predictive role of BTMs for fractures in individuals with and without T2D.
Main Methods:
- A case-cohort study design using data from the Health, Aging, and Body Composition (Health ABC) Study.
- Inclusion of 690 participants (aged 70-79 at baseline), including 223 incident fracture cases (hip, spine, forearm) over 9 years.
- Measurement of serum BTMs (CTX, OC, P1NP) at baseline and analysis using Cox regression.
Main Results:
- BTMs (CTX, OC, P1NP) did not predict incident fractures in participants with T2D.
- Higher CTX levels were associated with increased fracture risk in non-diabetic individuals (prediabetes and normoglycemia).
- A trend for association between OC and P1NP with fracture risk was observed in non-diabetic individuals, but not in T2D.
Conclusions:
- BTMs do not appear to be reliable predictors of incident fracture risk in individuals with T2D.
- BTMs showed a modest association with fracture risk in non-diabetic older adults.
- These findings suggest that fracture risk assessment in T2D may require different markers than those used in non-diabetic populations.
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