Objective To assess the fracture risk of elderly patients with and without type 2 diabetes mellitus (T2DM) by FRAX model, and to ascertain the validity of this model in assessing the fracture risk of elderly patients with T2DM in the mainland of China. Methods A total of 267 T2DM and 359 non-diabetic (control) patients were randomly selected, completed a questionnaire survey, underwent bone mineral density measurement, and were assessed by FRAX model. Binary regression analysis was used to evaluate the risk factors for high-risk fracture predicted by FRAX model. Results The body mass index (BMI), waist-hip ratio, and the proportions of smoking and drinking were all higher in the T2DM group than those in the control group (P<0.001). The bone mineral content, T value, and Z value of femoral neck (FN) and lumbar vertebra (L) in the T2DM group were also high. The T2DM group showed lower risks of 10-year major osteoporotic fracture (MOF) and hip fracture (HF) by FRAX-BMI model than the control group [(4.27±2.84)% vs. (5.14±2.92)%, P<0.001, and (1.42±1.54)% vs. (1.83±2.23)%, P<0.001]. The T2DM group also showed a lower risk of MOF by FRAX-BMD model than the control group [(5.28±4.41)% vs. (6.30±5.10)%, P<0.001]. Regression analysis results showed that the T score of FN, smoking, family history of hip fracture, and glucocorticoid use were associated with high-risk HF. The T score of FN, smoking, family history of HF, and history of brittle fracture were associated with high-risk MOF. T2DM was not associated with high-risk fracture predicted by the FRAX model. Conclusion The FRAX model predicts a lower 10-year fracture risk in elderly Chinese patients with T2DM than in non-diabetic patients, indicating that the model is not well suited for the Chinese population.
XIE Zhuangli
,
YANG Jun
,
XUAN Miao
,
JI Peifang
,
LI Ying
. Value of FRAX model in assessing fracture risk of Chinese elderly adults with type 2 diabetes[J]. Surgical Research and New Technique, 2021
, 10(1)
: 9
-13
.
DOI: 10.3969/j.issn.2095-378X.2021.01.003
[1] Xu Y, Wang L, He J, et al.Prevalence and control of diabetes in Chinese adults[J]. JAMA, 2013,310(9):948-959.
[2] Strotmeyer ES, Cauley JA.Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging, and body composition study[J]. Arch Intern Med,2005,165(14):1612-1617.
[3] Janghorbani M, Van Dam RM, Willett WC, et al.Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture[J]. Am J Epidemiol,2007,166(5):495-505.
[4] Vestergaard P.Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes--a meta-analysis[J]. Osteoporos Int, 2007 ,18(4):427-444.
[5] Cosman F, de Beur SJ, LeBoff MS, et al. Clinician's Guide to Prevention and Treatment of Osteoporosis[J]. Osteoporos Int, 2014,25(10):2359-2381.
[6] Yamamoto MYT, Yamauchi M, Kaji H, et al.Bone mineral density is not sensitive enough to assess the risk of vertebral fractures in type 2 diabetic women[J]. Calcif Tissue Int,2007, 80(6):353-358.
[7] Yamamoto MYT, Yamauchi M, Kaji H, et al.Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications[J]. JBMR ,2009,24(4):702-709.
[8] Kanis JA, Johnell O, Oden A,et al.FRAX and the assessment of fracture probability in men and women from the UK[J]. Osteoporos Int, 2008,19(4):385-97.
[9] Kanis JA, McCloskey EV, Johansson H,et al. Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK[J]. Osteoporos Int,2008,19(10):1395-1408.
[10] Vashishth D.The role of the collagen matrix in skeletal fragility[J]. Curr Osteoporos Rep. 2007,5(2):62-66.
[11] Tang SY, Allen MR, Phipps R, et al.Changes in non-enzymatic glycation and its association with altered mechanical properties following 1-year treatment with risedronate or alendronate[J]. Osteoporos Int, 2009,20(6):887-894.
[12] Yamamoto M, Yamaguchi T, Yamauchi M, et al.Low serum level of the endogenous secretory receptor for advanced glycation end products (esRAGE) is a risk factor for prevalent vertebral fractures independent of bone mineral density in patients with type 2 diabetes[J]. Diabetes Care,2009,32(12):2263-2268.
[13] Dobnig H, Piswanger-Solkner JC, Roth M, et al.Type 2 diabetes mellitus in nursing home patients: effects on bone turnover, bone mass, and fracture risk[J]. J Clin Endocrinol Metab,2006,91(9):3355-3363.
[14] Burghardt AJ, Issever AS, Schwartz AV, et al.High-resolution peripheral quantitative computed tomographic imaging of cortical and trabecular bone microarchitecture in patients with type 2 diabetes mellitus[J]. J Clin Endocrinol Metab, 2010,95(11):5045-5055.
[15] Giangregorio LM, Leslie WD, Lix LM, et al.FRAX underestimates fracture risk in patients with diabetes[J]. J Bone Miner Res, 2012,27(2):301-308.
[16] Chen XF, Li XL, Zhang H, et al.Were you identified to be at high fracture risk by FRAX(R) before your osteoporotic fracture occurred[J]. Clin Rheumatol, 2014,33(5):693-698.
[17] Zhang Z, Ou Y, Sheng Z, Liao E.How to decide intervention thresholds based on FRAX in central south Chinese postmenopausal women[J]. Endocrine,2014,45(2):195-197.