Center for Diabetes, Endocrinology, and Metabolism, Toho University Sakura Medical Center, Chiba, Japan.
Department of Clinical Cell Biology & Medicine, Graduate School of Medicine, Chiba University, Chiba, Japan.
Am J Med Sci. 2020 Nov;360(5):552-559. doi: 10.1016/j.amjms.2020.04.002. Epub 2020 Apr 11.
Diabetes carries a known risk of bone fracture despite high bone mineral density (BMD). The fracture risk assessment tool (FRAX) predicts the 10-year major osteoporotic fracture risk and hip fracture risk. We investigated the effects of clinical parameters on the FRAX score and evaluated the validity of FRAX for evaluating current bone fragility in diabetes subjects.
Forty-seven thousand, three hundred eighty-nine Japanese women participated in the Chiba bone survey, a population-based, multicenter, cross-sectional study of postmenopausal osteoporosis; we estimated FRAX scores without BMD and compared scores between subjects with and without type 2 diabetes.
Mean FRAX major osteoporotic fracture risk was significantly higher in the diabetes group. A multiple regression model demonstrated some clinical parameters that affected the FRAX score and, after adjusting for such parameters, the FRAX score was not significantly different between the diabetes and nondiabetes groups, although the type 2 diabetes rate was significantly higher in subjects with a fracture in the past 5 years, which reflected current bone fragility. After adjusting for clinical parameters, the diabetes rate remained significantly higher in subjects with a fracture in the past 5 years, confirming that type 2 diabetes influences current bone fragility. Our study demonstrated that type 2 diabetes truly carries a risk of bone fracture, but adjusted FRAX major osteoporotic fracture risk is not significantly different between subjects with and without type 2 diabetes.
The FRAX major osteoporotic fracture risk without BMD does not correctly indicate current bone fragility in Japanese middle-aged women with type 2 diabetes.
尽管骨密度（BMD）较高，糖尿病仍存在已知的骨折风险。骨折风险评估工具（FRAX）可预测 10 年主要骨质疏松性骨折风险和髋部骨折风险。我们研究了临床参数对 FRAX 评分的影响，并评估了 FRAX 评估糖尿病患者当前骨脆弱性的有效性。
47389 名日本女性参加了千叶骨调查，这是一项基于人群的、多中心、绝经后骨质疏松症的横断面研究；我们估算了不基于 BMD 的 FRAX 评分，并比较了有和无 2 型糖尿病受试者的评分。
糖尿病组的 FRAX 主要骨质疏松性骨折风险评分显著更高。多元回归模型显示了一些影响 FRAX 评分的临床参数，在调整这些参数后，糖尿病组和非糖尿病组的 FRAX 评分无显著差异，尽管过去 5 年内有骨折的受试者 2 型糖尿病发生率显著更高，反映了当前的骨脆弱性。在调整临床参数后，过去 5 年内有骨折的受试者中 2 型糖尿病的发生率仍然显著更高，证实 2 型糖尿病确实会增加骨折风险。我们的研究表明，2 型糖尿病确实存在骨折风险，但调整后的 FRAX 主要骨质疏松性骨折风险在有和无 2 型糖尿病的受试者之间无显著差异。
不基于 BMD 的 FRAX 主要骨质疏松性骨折风险不能正确指示日本中年女性 2 型糖尿病患者当前的骨脆弱性。
