Assessment of fracture risk in patients with type 2 diabetes mellitus

Abstract

Fracture risk is higher in the patients with type 2 diabetes mellitus (T2DM) comparing to non-diabetic subjects, but bone mineral density (BMD) in type 2 diabetic patients may be increased, normal or decreased compared to non-diabetic population. Thus, BMD is not an accurate index for deciding to start antiosteoporotic treatment in type 2 diabetic patients with high fracture risk, and the more accurate assessment tools which can reflect the fracture risk in type 2 diabetic patients are needed. Studies have shown that the fracture risk in type 2 diabetic patients is increased with the decreasing of BMD, but the fracture usually happened with relative high BMD. Trabecular bone score is lower in type 2 diabetic patients than that in non-diabetic patients. High-resolution peripheral quantitative computed tomography (HR-pQCT) accurately reflects the bone microstructure of T2DM. FRAX may get more accurate fracture risk in type 2 diabetic patients by replacing rheumatoid arthritis with T2DM. DeFRA is a new algorithm derived from FRAX, which can evaluate fracture risk more accurately than FRAX in type 2 diabetic patients. Skeletal muscle mass is decreased in type 2 diabetic patients. Pentosidine, as one of advanced glycation end products, is related to the fracture risk in type 2 diabetic patients. Based on these data, this paper will review the assessments which may be used to evaluate the fracture risk in type 2 diabetic patients. Key words: Diabetes mellitus, type 2; Fracture risk; Evaluation; Bone mineral density; Bone microstructure