BONE TURNOVER AND FRACTURE RISK IN POSTMENOPAUSAL WOMEN WITH TYPE 2 DIABETES

Introduction. Bone fragility is increasingly recognized as a complication of type 2 diabetes (T2DM). However, the underestimation of fracture (Fx) risk in T2DM using the classical assessment tools pointed out the need of clinical recommendations for the evaluation of bone health in T2DM. The multidisciplinary expert panel chaired by Chiodini suggested the diagnostic approaches for the detection of T2DM patients worthy of bone-active treatment (Chiodini I et al, Nutr Metab Cardiovasc Dis. 2021). Aims. The aim of the study was to apply these algorithms to a well characterized cohort of postmenopausal women with T2DM to validate them in clinical practice. Materials and methods. The presence of the major T2DM-specific Fx risk factors (a disease duration ≥10 years, one or more chronic T2DM complications, the use of insulin or thiazolidinediones and persistent poor glycaemic control) was ascertained at baseline in 107 female subjects with T2DM. They were conservatively followed-up. At baseline and after follow-up we evaluated bone mineral density (BMD) and the presence of clinical and morphometric vertebral Fx. Results. Following the flow-charts, 34 (31.8%) and 73 (68.2%) patients would have been pharmacologically and conservatively treated, respectively. Among the 49 patients without both clinical Fx and major T2DM-related risk factors, who would have been, therefore, conservatively followed-up, only one subject showed a prevalent vertebral Fx (sensitivity 90%, negative predictive value 98%). After the follow-up the BMD variation in T2DM patients who would have been pharmacologically treated did not differ from that observed in T2DM patients who would have been conservatively followed-up. Two patients experienced an incident Fx and both would have been pharmacologically treated at baseline. Conclusions. The clinical consensus recommendations established by the Italian multidisciplinary expert panel performed well in our sample of postmenopausal women with T2DM. Indeed, among those subjects with bone-active treatment indication as many as 15.3% of patients experienced an incident Fx fracture (incident rate 30 Fx per 1000 patient-years), thus confirming a high Fx risk worthy of specific treatment and, conversely, among those subjects without bone-active treatment indication no incident Fx were observed.