Fracture risk assessment (FRAX) without BMD and risk of major osteoporotic fractures in adults with type 1 diabetes.

Abstract

To evaluate the association between Fracture Risk Assessment Tool (FRAX) without bone mineral density (BMD) and risk for major osteoporotic fractures (MOF) in type 1 diabetes. Subjects with type 1 diabetes and without diabetes from the 'Coronary Artery Calcification in Type 1 Diabetes' study were included. Risk for MOF was calculated using FRAX-based clinical risk factors and without BMD at visit 3 (2006-2008). Incident fractures were defined as fractures that occurred between visit 3 and visit 4 (2013-2017). Survival models were used to study the predictability of new MOF by diabetes status. 346 type 1 diabetes (mean age 43.3±9, BMI 26.4±5, diabetes duration 29.4±8.6years, A1c 7.8±1.1) and 411 controls (mean age 46.9±9years, BMI 26.3±5kg/m2, A1c 5.5±0.4) were analyzed in this study. In unadjusted survival analysis, the FRAX score without BMD was significantly associated with MOF (HR 1.08, 95% CI: 1.04-1.13, p<0.0001), and remained significantly associated after adjustment for age and sex (HR 1.09, 95% CI: 1.04-1.15, p=0.0007) and type 1 diabetes (HR 1.08, 95% CI: 1.04-1.12, p=0.0002). In the fully adjusted model (adjusted for age, sex and type 1 diabetes), the FRAX score without BMD was the only variable significantly associated with risk of MOF (HR 1.08, 95% CI: 1.02-1.14, p=0.006). Clinical use of FRAX without BMD is useful tool in identifying adults with type 1 diabetes at higher risk for MOF risk and may help clinicians to guide therapeutic decision-making in this high fracture risk population.