Evaluation Of Fracture Risk In Postmenopausal Women With Type 2 Diabetes Mellitus Based On Calcaneus Quantitative Ultrasound

Objective:To evaluate fracture risk in postmenopausal women with type 2 diabetes mellitus(T2DM)based on quantitative ultrasound(QUS).Methods:Postmenopausal women with T2 DM from Department of Endocrinology,The Anhui Provincial Hospital Affiliated to Anhui Medical University from 2012 to 2017 were enrolled in this study and assigned into T2 DM group(n=492).And healthy postmenopausal women from physical examination center were assigned into NC group(n=398).Bone strength index(SI)and bone mineral density(BMD)were measured by QUS and dual energy X ray absorptiometry(DXA)respectively in the two groups.Bone turnover markers were tested.Fracture Risk Assessment Tool(FRAX)was used to predict the risk of major osteoporotic fracture(PMOF)and the probability of hip fracture(PHF).SI,BMD,PMOF,PHF and bone turnover markers were compared between the two groups.Results:(1)There was no statistically significant difference in BMD and osteoporosis prevalence between T2 DM group and NC group(all P>0.05).The SI was lower(P<0.05),PMOF and PHF were higher(P<0.05 or P<0.01)in T2 DM group than in NC group.(2)The25-hydroxyvitamin D [25(OH)D],osteocalcin(BGP),procollagen type 1 aminoterminal propeptide(PINP),and cross-linked C-terminal telopeptide of type I collagen(?-CTX)were decreased,while PTH was increased in T2 DM group than in NC group(P<0.05 or P<0.01).(3)There was no statistically significant difference in measuring of bone mass between DXA and QUS in NC group(P >0.05).Whereas,the odds of QUS stiffness T score(?—2.5)was lower than that of BMD(FN)measured by DXA In T2 DM group(P>0.05).(4)The sensitivity and specificity regarding to FRAX scores were higher in QUS than in DXA in T2 DM group(37%vs25%,98%vs90%).(5)In T2 DM group,multivariate regression analysis revealed that SI,?-CTX and PINP were negatively correlated with PMOF(?=—0.251,—0.132,—0.235,P <0.05 or P<0.01);and SI,?-CTX were negatively correlated with PHF(?=—0.163,—0.132,P<0.05).Conclusion:(1)The prevalence of bone mineral density and osteoporosis in postmenopausal women with type 2 diabetes is no different from that of normal healthy postmenopausal women,but the risk of fracture is increased.(2)Quantitative ultrasound and bone metabolism markers may have certain value in assessing the risk of fracture in postmenopausal women with type 2 diabetes.