Comparison of quantitative ultrasound of calcaneus and dual energy X-ray absorptiometry in measuring bone density and predicting fractures in patients with diabetic polyneuropathy: A prospective cohort study

Ugarph-Morawski Anna,Sääf Maria,Brismar Kerstin

doi:10.1016/j.diabres.2021.109064

Ugarph-Morawski Anna, Sääf Maria + Show 1 more

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https://doi.org/10.1016/j.diabres.2021.109064

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Abstract

AimsCompare quantitative ultrasound (QUS) of calcaneus and dual energy X-ray absorptiometry (DXA) as measurements of bone density, calculate 20-year fracture incidence in patients with T1DM and T2DM and multiple complications, and compare the methods’ predictive ability. MethodsSixty-two hospital foot clinic patients with T1DM or T2DM and complications were followed (1995–2015; 610 person-years). Clinical assessments and QUS of calcaneus were performed on all at inclusion and DXA of the spine and femoral neck on a subgroup (n = 34). Fracture incidence was assessed at follow-up and compared to incidence in the general population. We evaluated the correlation between QUS of calcaneus and DXA (Pearson’s correlation test) and the association between bone density and fracture incidence at follow-up (logistic regression). ResultsBone density (QUS of calcaneus) correlated with hip bone density (DXA). Incidence of all fractures (30/62 patients; 48%) and hip fractures (6/62 patients; 10%) was higher in patients than the general population. Twelve (19%) experienced foot fracture. QUS of calcaneus predicted hip, lower leg, and foot fractures; DXA did not. ConclusionsBecause QUS of calcaneus predicted fractures in patients with diabetes and multiple complications, it seems appropriate to test QUS of calcaneus as a fracture risk predictor in primary care.

Highlights

Diabetes, a metabolic disease, and osteoporosis, a disease characterized by bone fragility, are common chronic disorders that are increasing in prevalence worldwide as the population ages [1,2]
There was no significant difference in fracture incidence between patients with T1DM and T2DM or between men and women
We found that age-adjusted bone density of the spine and of the femoral neck was lower in those with T1DM than in those with T2DM

Summary

Introduction

A metabolic disease, and osteoporosis, a disease characterized by bone fragility, are common chronic disorders that are increasing in prevalence worldwide as the population ages [1,2]. The connection between diabetes and bone strength remains unclear [5], studies indicate that both Type 1 diabetes (T1D) [6] and Type 2 diabetes (T2D) [7] are risk factors for osteoporotic fractures. In Europe, the cost of osteoporosis, including fractures and pharmacological treatment, was approximately 37 billion Euros in 2010 [10]. Age was treated as a continuous variable. Diabetes duration, defined as years elapsed since age at DM onset, was treated as a continuous variable. Patients were divided into those with and without insulin treatment

Results

Discussion

Conclusion