Santos Monteiro Sílvia, da Silva Santos Tiago, Fonseca Liliana, Dores Jorge
Endocrinology, Diabetes and Metabolism, Centro Hospitalar Universitário de Santo António (CHUdSA), Porto, PRT.
Cureus. 2023 Feb 20;15(2):e35205. doi: 10.7759/cureus.35205. eCollection 2023 Feb.
Fragility fractures are increasingly recognized as a complication of type 2 diabetes mellitus (T2DM). The FRAX-Port® is a calculation tool that assesses the 10-year risk of either major and hip fracture, integrating several clinical risk factors, including T2DM. We aimed to evaluate the fracture risk in adults with T2DM and determine the rate of patients at high risk for fracture under anti-osteoporotic therapy.
We developed a cross-sectional study, including a convenience sample of adults with T2DM, followed in our tertiary center between 2019 and 2022. Fracture risk was evaluated according to FRAX-Port®.
One hundred adults were included, 54% male, with a mean age of 68.4±9.2 years. Respecting fracture risk factors, 17% had a previous fragility fracture, 12% had a history of hip fracture in their parents, 9% had active alcohol consumption, and 4% had active smoking. Additionally, 17% presented secondary osteoporosis, being the most frequent cause of systemic corticosteroid exposure (10%). Regarding diabetes-specific risk factors, 94% had a diabetes duration longer than five years; HbA1c greater than 7% in 70%; 42% had diabetic retinopathy, 33% had diabetic chronic kidney disease, 18% had peripheral neuropathy, and 7% had autonomic neuropathy; 83% were on insulin, 2% on canagliflozin and 1% on pioglitazone. According to the FRAX-Port®, the median probability of major fracture was 6.8% (IQR 6.9), and hip fracture was 2.4% (IQR 3.9). Fracture risk was high, intermediate, and low at 41%, 15%, and 44%, respectively. Lastly, 56% of participants should undergo bone densitometry and 45% had a formal recommendation to begin an anti-osteoporotic treatment. However, only 6% were under anti-osteoporotic therapy: bisphosphonates (5%) and denosumab (1%).
More than a third of T2DM patients evaluated had a high fracture risk. We found that FRAX-Port® is an easy-to-apply tool, which helps in the decision to perform densitometry or to institute anti-osteoporotic therapy. Given the increasing prevalence of T2DM and the associated risk of falls, this study highlights the need to recognize the fracture risk in these patients, usually a forgotten complication during the screening of risk factors for adverse events in adults with T2DM.
脆性骨折日益被认为是2型糖尿病（T2DM）的一种并发症。FRAX-Port®是一种计算工具，可评估主要骨折和髋部骨折的10年风险，整合了包括T2DM在内的多种临床风险因素。我们旨在评估T2DM成人患者的骨折风险，并确定接受抗骨质疏松治疗的高骨折风险患者比例。
我们开展了一项横断面研究，纳入了在2019年至2022年期间于我们的三级中心就诊的T2DM成人便利样本。根据FRAX-Port®评估骨折风险。
共纳入100名成人，男性占54%，平均年龄为68.4±9.2岁。在骨折风险因素方面，17%曾有脆性骨折史，12%的父母有髋部骨折史，9%有活跃饮酒情况，4%有活跃吸烟情况。此外，17%存在继发性骨质疏松，最常见的原因是全身性皮质类固醇暴露（10%）。关于糖尿病特异性风险因素，94%的糖尿病病程超过5年；70%的糖化血红蛋白大于7%；42%有糖尿病视网膜病变，33%有糖尿病慢性肾病，18%有周围神经病变，7%有自主神经病变；83%使用胰岛素，2%使用卡格列净，1%使用吡格列酮。根据FRAX-Port®，主要骨折的中位概率为6.8%（四分位间距6.9），髋部骨折为2.4%（四分位间距3.9）。骨折风险高、中、低的比例分别为41%、15%和44%。最后，56%的参与者应进行骨密度测定，45%有正式建议开始抗骨质疏松治疗。然而，只有6%的患者正在接受抗骨质疏松治疗：双膦酸盐（5%）和地诺单抗（1%）。
超过三分之一接受评估的T2DM患者骨折风险高。我们发现FRAX-Port®是一种易于应用的工具，有助于决定是否进行骨密度测定或开始抗骨质疏松治疗。鉴于T2DM的患病率不断上升以及相关的跌倒风险，本研究强调了认识这些患者骨折风险的必要性，这在T2DM成人不良事件风险因素筛查中通常是一个被遗忘的并发症。
