Application of Calcaneal Ultrasonography for Long-Term Fracture Risk Assessment in Diabetic Osteopathy

Bone densitometry and fracture risk algorithms have proved scarce reliability for fractures risk estimation in patients with diabetic osteopathy. Calcaneal quantitative ultrasound (QUS) is a noninvasive, low-cost technique already acknowledged for fracture risk assessment in patients with primary osteoporosis. Nevertheless, there is limited evidence on the role of QUS in patients with diabetes mellitus (DM). The aim of our study was to evaluate whether calcaneal QUS may effectively estimate long-term risk of fragility fractures in a group of patients with DM.

We conducted a retrospective study including 300 patients with type 1 (T1DM) or type 2 DM (T2DM) who underwent calcaneal QUS evaluation in 2013. Information about clinical fragility fractures, DM characteristics, and QUS parameters (broadband ultrasound attenuation, BUA; speed of sound, SOS; stiffness index, SI) were collected through electronic medical records. Ten years later, the patients were asked to participate to an interview about clinical fragility fractures occurring within the decade 2013-2023.

At baseline, thirty-nine patients (13%) presented with at least one fragility fracture at any site. Fractured patients showed significantly lower QUS parameters than non-fractured (p < 0.0001), both in T1DM (n = 106) and in T2DM (n = 194). In 2023, 231 patients (132 with T2DM and 99 with T1DM) participated to the follow-up interview; 31 patients (13%) referred the occurrence a new clinical fragility fracture, and 14 patients (6%) a major osteoporotic fractures (MOF). Among QUS parameters, BUA was significantly associated to the occurrence of new MOF over 10-years in T2DM (p < 0.01), but not in T1DM.

Calcaneal QUS may represent an effective tool in assessment of fracture risk among patients with T2DM.