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Validation of the clinical consensus recommendations on the management of fracture risk in postmenopausal women with type 2 diabetes

Published:October 10, 2022DOI:https://doi.org/10.1016/j.numecd.2022.10.004

      Highlights

      • The fracture risk in type 2 diabetes is underestimated using the classical tools.
      • Algorithms for the detection of patients at high fracture risk have been suggested.
      • They showed a good sensitivity in identifying diabetic women at high fracture risk.
      • As many as 13% of patients with treatment indication experienced an incident fracture.

      Abstract

      Background and aims

      Bone fragility is recognized as a complication of type 2 diabetes (T2D). However, the fracture risk in T2D is underestimated using the classical assessment tools. An expert panel suggested the diagnostic approaches for the detection of T2D patients worthy of bone-active treatment. The aim of the study was to apply these algorithms to a cohort of T2D women to validate them in clinical practice.

      Methods and results

      The presence of T2D-specific fracture risk factors (T2D ≥ 10 years, ≥1 T2D complications, insulin or thiazolidinedione use, poor glycaemic control) was assessed at baseline in 107 postmenopausal T2D women. In all patients at baseline and in 34 patients after a median follow-up of 60.2 months we retrospectively evaluated bone mineral density and clinical and morphometric vertebral fractures. No patient was treated with bone-active drug. Following the protocols, 34 (31.8%) and 73 (68.2%) patients would have been pharmacologically and conservatively treated, respectively. Among 49 patients without both clinical fractures and major T2D-related risk factors, who would have been, therefore, conservatively followed-up without vertebral fracture assessment, only one showed a prevalent vertebral fracture (sensitivity 90%, negative predictive value 98%). The two patients who experienced an incident fracture would have been pharmacologically treated at baseline.

      Conclusions

      The clinical consensus recommendations showed a very good sensitivity in identifying T2D postmenopausal women at high fracture risk. Among those with treatment indication as many as 13% of patients experienced an incident fracture, and, conversely, among those without treatment indication no incident fractures were observed.

      Keywords

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