10-Year Fracture Risk Assessment with Novel Adjustment (FRAXplus): Type 2 Diabetic Sample-Focused Analysis

Area of Science:

• Endocrinology and Bone Metabolism
• Geriatric Medicine
• Metabolic Bone Diseases

Background:

• Type 2 diabetes (T2D) is a recognized risk factor for osteoporotic fractures, particularly in postmenopausal women.
• Accurate fracture risk assessment in this demographic is crucial for timely intervention and management.

Purpose of the Study:

• To evaluate bone status (mineral metabolism, bone turnover markers, DXA-BMD) in menopausal women with and without T2D.
• To compare 10-year fracture probabilities using conventional FRAX and a novel FRAXplus model incorporating T2D and lumbar spine BMD.

Main Methods:

• Retrospective, cross-sectional pilot study of 136 menopausal women (aged 50-80) with or without T2D.
• Assessed mineral metabolism, bone turnover markers (osteocalcin, CrossLaps), 25-hydroxyvitamin D, and DXA-BMD (femoral neck, lumbar spine).
• Calculated 10-year fracture probabilities using FRAX (without/with femoral neck BMD) and FRAXplus (with T2D and lumbar spine BMD adjustments).

Main Results:

• T2D group showed higher BMI, but lower osteocalcin, CrossLaps, and 25-hydroxyvitamin D compared to non-T2D controls.
• Femoral neck and total hip BMD were higher in the T2D group.
• The novel FRAXplus model with lumbar spine BMD adjustment indicated lower fracture probabilities than conventional FRAX or T2D-adjusted FRAXplus.

Conclusions:

• Menopausal women with T2D exhibit distinct bone metabolism profiles, including lower bone turnover markers and vitamin D, and higher bone density.
• Conventional FRAX may underestimate fracture risk in T2D menopausal women; the FRAXplus model offers a potentially more accurate assessment.
• Tailored fracture risk assessment strategies are needed for diabetic menopausal women to improve bone health and reduce fracture burden.