title: The importance of morphometric radiographic vertebral assessment for the detection of patients who need pharmacological treatment of osteoporosis among postmenopausal diabetic Korean women.
abstract: Many diabetic patients with vertebral fractures remain undiagnosed and untreated. We found that more than two-thirds of osteoporotic diabetic women could not be identified for pharmacological treatment according to the NOF guidelines if without radiographic vertebral assessment. This study shows the importance of radiographic vertebral assessment for identifying patients who need treatment for osteoporosis in diabetic women.
  
  
  BACKGROUND
  Diagnosis of vertebral fracture (VF) is important for identifying patients who need pharmacologic therapy for osteoporosis. However, many patients with vertebral fractures remain undiagnosed and untreated. This study evaluated the number of patients with VFs who would be unrecognized as candidates for osteoporosis treatments according to the National Osteoporosis Foundation (NOF) Clinician’s Guidelines to the Treatment of Osteoporosis, among postmenopausal diabetic Korean women without spinal imaging.
  
  
  METHODS
  A total of 873 postmenopausal diabetic women were enrolled. Lateral plain radiographs of the thoracolumbar spine and total hip BMD were obtained. The Fracture Risk Assessment Tool (FRAX®) probability was computed using the algorithm available online at http://www.shef.ac.uk/FRAX (South Korea version). The subjects with and without VFs were classified into candidates for osteoporosis treatment [Tx+by NOF] and not candidates for osteoporosis treatment [Tx−by NOF] according to the NOF pharmacologic treatment guidelines, regardless of the presence of VFs.
  
  
  RESULTS
  Forty-six percent of postmenopausal diabetic womenhad morphometric VFs. Among the subjects with morphometric VFs, only 2% of the patients had previously diagnosed VFs by medical doctors. In addition, 73.6% of the patients with VFs were not included in the [Tx+by NOF] group, given the assumption of no radiographic diagnosis of VFs.
  
  
  CONCLUSIONS
  With regard to increased risk of VFs in postmenopausal Korean women with type 2 diabetes mellitus, radiographic vertebral assessment would be useful for the clinical identification of osteoporosis and fractures.
authors: Department of Endocrinology and Metabolism, Ajou University School of Medicine, Suwon, South Korea.
authors: Y J
authors: YJ
authors: Choi
authors: S-O
authors: SO
authors: Yang
authors: C S
authors: CS
authors: Shin
authors: Y-S
authors: YS
authors: Chung
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000465:Algorithms; D015519:Bone Density; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D005260:Female; D006615:Hip / Q000000981:diagnostic imaging*; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging*; D008875:Middle Aged; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D058866:Osteoporotic Fractures / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D056910:Republic of Korea; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D016103:Spinal Fractures / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging*