| Objective1. To evaluate FRAX-estimated probability of osteoporotic fracture in patients with newly diagnosed type 2 diabetes.2. To study the application of the FRAX algorithm in assessing fracture risk in type 2 diabetes mellitus (DM) patients.MethodsIn our cross-sectional study, we investigated patients with type 2 diabetes mellitus (DM) from the inpatient department of the hospital between February 2013 and April 2014.278 subjects were selected from patients with diabetes mellitus including 136 male cases and 142 female cases.207 subjects were patients with newly diagnosed type 2 diabetes mellitus (DM group) including 119 male cases and 88 female cases.504 subjects were selected in the same period from medical examination population without diabetes as normal control group (NC group) including 141 male cases and 363 female cases. The inclusion diagnostic criteria for type 2 diabetes were referenced based on 1999 World Health Organization (WHO) standards. Exclusion criteria were applied to: 1. Subjects who had a history of any osteoarticular diseases and other diseases (such as thyroid disease, hyperthyroidism, primary or secondary hyperparathyroidism); 2. Subjects who had a history of taking such drugs as corticosteroids, sex hormone, diphosphonate and active vitamin D that could affect bone and calcium metabolism; 3. Subjects who had a potential of increased bone loss that were excluded including those with severe liver, heart, lung or renal dysfunction; 4. Subjects who were pregnant or lactating; 5. Subjects who were patients with DM taking thiazolidinedione; 6. Subjects who were patients with Type 1 DM, GDM or other particular diabetic diseases.A standardized questionnaire was applied to collect from the subjects data of habits, customs and history of disease. FRAX surveys were used to record information of the subjects about age, sex, body mass index (BMI), prolonged corticosteroid therapy, rheumatoid arthritis, secondary osteoporosis, previous fragility fracture, smoking or alcohol abuse, parental history of hip fracture.The unified standard was employed in patients to measure the height, weight, waist circumference, hip circumference and blood pressure, and thus calculate body mass index (BMI= weight (kg)height2 (m2).Each participant had postero-anterior position measurements of L1-L4 lumbar spine and the femoral bone mineral density (BMD) by DXA using a Dual Energy X-Ray Bone Densitometer (GE, Lunar Prodigy densitometer, USA). The measurements were performed by the same experienced doctor.FRAX score is generated and calculated by the FRAX(?) tool on the website http://www.shef.ac.uk/FRAX. According to FRAX questionnaire and whether to enter the femoral neck bone mineral density, this algorithm allows to estimate the 10-year probability of hip fracture(PHF) with or without bone mineral density and the 10-year probability of major osteoporotic fractures(PMOF) with or without bone mineral density.Diabetes related clinical profiles were collected by means of consulting the medical records of diabetic group and recording OGTT, insulin level, c peptide level, HBAIC, liver function, renal function, blood lipid level, uric acid, disease duration and previous hypoglycaemic events. According to the hypoglycemic therapy, the subjects were divided into insulin group and oral medications group(excluding TZDs drugs). Macrovascular disease was diagnosed when the patients had at least one of the following:previous history of exertion angina or positive exertion EKG test, myocardial infarction or coronary revascularization procedures (bypass or percutaneous transluminal coronary angioplasty), significant carotid stenosis or previous endoarterectomy, peripheral artery disease, and previous documented stroke. In particular, possible retinal involvement was periodically checked by ophthalmoscopy, and neuropathy screening was carried out with the Diabetic Neuropathy Index, and nephropathy was diagnosed when microalbuminuria and/or reduced eGFR was detected.Patients’baseline clinical characteristics were reported as frequency (percentages) and mean ± standard deviation (SD) for categorical and continuous variables, respectively. Comparisons between continuous variables were performed using two-sample t-test. The mutiple-linear regression analysis was performed to test the association between FRAX score and clinic diabetes-related index. A p-value<0.05 was considered for statistical significance.Results1. Evaluating FRAX-estimated probability of osteoporotic fracture in patients with newly diagnosed type 2 diabetes illustrates:1.1 The frequency of previous fracture in DM group was higher than in NC group(P<0.05). The T value at femur neck and lumbar spine in DM group were higher than NC group.1.2. The 10-year probability of both major osteoporotic fractures (PMOF) and hip fractures (PHF) calculated by FRAX in the overall sample and in men with newly diagnosed type 2 diabetes was lower than that in control subjects (p<0.05). The proportion of subjects who had experienced previous hip fractures was higher in patients with diabetes than in control subjects (p<0.05). The ten-year probability of both major osteoporotic fractures (PMOF) and hip fractures (PHF) calculated by FRAX in the overall sample and in women with newly diagnosed diabetes was lower than that in control subjects (p<0.05). The proportion of subjects who had experienced previous major osteoporotic and hip fractures was higher in patients with diabetes than in control subjects (p<0.05).1.3. The 10-year probability of both major osteoporotic and hip fractures had an increased trend with the increasing age (p<0.05).2. Assessment of fracture risk by the FRAX score in type 2 diabetes illustrates:2.1. PMOF and PHF have a positive correlation with sex, age, HBAIC, disease duration, diabetic retinopathy, nephropathy, macrovascular complications of diabetes, and the presence of hypoglycaemia (P<0.05), have a negative relationship with BMI.2.2 The mutiple-linear regression analysis illustrates PMOF and PHF have a linear correlation with sex (r=0.316,0.097), age (r=0.339,0.402), glycosylated hemoglobin (r=0.030,0.076), the presence of hypoglycaemia (r=0.13,0.135), BMI (r=-0.004,-0.063) which has statistical significance.Conclusion1. The proportion of subjects who had experienced previous fractures was significantly higher in DM group than in NC group, but L、 3、 4 lumbar spine and the femoral bone mineral density (BMD)of patients with diabetes was significantly higher than in control subjects.2. The 10-year probability of both major osteoporotic fractures (PMOF) and hip fractures (PHF) calculated by FRAX in subjects with type 2 diabetes mellitus was lower than that in control subjects (p<0.05).3. PMOF and PHF have a positive correlation with clinical risk factors of sex, age, HBAIC, disease duration, diabetic retinopathy, nephropathy, macrovascular complications of diabetes, and the presence of hypoglycaemia, and a negative relationship with BMI。4. FRAX tools actually underestimate the fracture risk in patients with diabetes. |
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