title: Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes.
abstract: BACKGROUND
  Type 2 diabetes mellitus (DM) is associated with higher bone mineral density (BMD) and paradoxically with increased fracture risk. It is not known if low BMD, central to fracture prediction in older adults, identifies fracture risk in patients with DM.
  
  
  OBJECTIVE
  To determine if femoral neck BMD T score and the World Health Organization Fracture Risk Algorithm (FRAX) score are associated with hip and nonspine fracture risk in older adults with type 2 DM.
  
  
  METHODS
  Data from 3 prospective observational studies with adjudicated fracture outcomes (Study of Osteoporotic Fractures [December 1998-July 2008]; Osteoporotic Fractures in Men Study [March 2000-March 2009]; and Health, Aging, and Body Composition study [April 1997-June 2007]) were analyzed in older community-dwelling adults (9449 women and 7436 men) in the United States.
  
  
  METHODS
  Self-reported incident fractures, which were verified by radiology reports.
  
  
  RESULTS
  Of 770 women with DM, 84 experienced a hip fracture and 262 a nonspine fracture during a mean (SD) follow-up of 12.6 (5.3) years. Of 1199 men with DM, 32 experienced a hip fracture and 133 a nonspine fracture during a mean (SD) follow-up of 7.5 (2.0) years. Age-adjusted hazard ratios (HRs) for 1-unit decrease in femoral neck BMD T score in women with DM were 1.88 (95% confidence interval [CI], 1.43-2.48) for hip fracture and 1.52 (95% CI, 1.31-1.75) for nonspine fracture, and in men with DM were 5.71 (95% CI, 3.42-9.53) for hip fracture and 2.17 (95% CI, 1.75-2.69) for nonspine fracture. The FRAX score was also associated with fracture risk in participants with DM (HRs for 1-unit increase in FRAX hip fracture score, 1.05; 95% CI, 1.03-1.07, for women with DM and 1.16; 95% CI, 1.07-1.27, for men with DM; HRs for 1-unit increase in FRAX osteoporotic fracture score, 1.04; 95% CI, 1.02-1.05, for women with DM and 1.09; 95% CI, 1.04-1.14, for men with DM). However, for a given T score and age or for a given FRAX score, participants with DM had a higher fracture risk than those without DM. For a similar fracture risk, participants with DM had a higher T score than participants without DM. For hip fracture, the estimated mean difference in T score for women was 0.59 (95% CI, 0.31-0.87) and for men was 0.38 (95% CI, 0.09-0.66).
  
  
  CONCLUSIONS
  Among older adults with type 2 DM, femoral neck BMD T score and FRAX score were associated with hip and nonspine fracture risk; however, in these patients compared with participants without DM, the fracture risk was higher for a given T score and age or for a given FRAX score.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California San Francisco, 185 Berry St, Lobby 5, Ste 5700, San Francisco, CA 94107-1762, USA. aschwartz@psg.ucsf.edu
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
authors.forename: Eric
authors.initials: E
authors.lastname: Vittinghoff
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Teresa A
authors.initials: TA
authors.lastname: Hillier
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: Meghan G
authors.initials: MG
authors.lastname: Donaldson
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Annemarie
authors.initials: A
authors.lastname: Koster
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Womack
authors.forename: Lisa
authors.initials: L
authors.lastname: Palermo
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Black
mesh_terms: D000367:Age Factors; D000368:Aged; D000465:Algorithms; D015519:Bone Density; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D005260:Female; D005272:Femur Neck; D006620:Hip Fractures / Q000453:epidemiology*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012306:Risk; D014944:World Health Organization
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin