Diabetes is associated with higher fracture risk. In type 1 diabetes, hip fracture risk is about 4-5 times higher than for non-diabetic patients. In type 2 diabetes, the increased risk is more modest, about 1.3-1.7 times higher. However, type 2 diabetes affects over a quarter of older adults in the US, resulting in a substantial absolute increase in fracture risk. While fracture risk is increased, bone mineral density in type 2 patients tends to be higher than in those without diabetes. As a result, standard tools for fracture risk assessment, BMD T-score and FRAX, tend to under-estimate risk in type 2 diabetes. This seminar will discuss the challenges of fracture risk assessment in diabetic patients. The growing interest in fracture risk in diabetic patients has led to the identification of several diabetes-specific risk factors for fracture, including poor glycemic control, duration of diabetes, hypoglycemia, and treatments for diabetes that will be reviewed in the webinar. Another area of research is the effort to identify the underlying reasons for diabetic bone fragility. The webinar will consider the latest findings on advanced glycation end products, bone microarchitecture and reference point indentation as possible contributing factors to fragility of diabetic bone, independent of areal BMD.
As a result of participating in this session, learners should be able to:
- Identify under-estimation of fracture risk with BMD T-score or FRAX in diabetic patients
- Describe diabetes-specific risk factors for fracture
- Discuss effects of diabetes medications on skeletal health