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Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes

Schwartz, AV and Vittinghoff, E and Bauer, DC and Hillier, TA and Strotmeyer, ES and Ensrud, KE and Donaldson, MG and Cauley, JA and Harris, TB and Koster, A and Womack, CR and Palermo, L and Black, DM (2011) Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA - Journal of the American Medical Association, 305 (21). 2184 - 2192. ISSN 0098-7484

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Abstract

Context: 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. Design, Setting, and Participants: 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. Main OutcomeMeasure: 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 neckBMD 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. ©2011 American Medical Association. All rights reserved.


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Details

Item Type: Article
Status: Published
Creators/Authors:
CreatorsEmailPitt UsernameORCID
Schwartz, AV
Vittinghoff, E
Bauer, DC
Hillier, TA
Strotmeyer, ESstrotmeyere@edc.pitt.eduELSST21
Ensrud, KE
Donaldson, MG
Cauley, JAJCauley@edc.pitt.eduJCAULEY
Harris, TB
Koster, A
Womack, CR
Palermo, L
Black, DM
Date: 1 June 2011
Date Type: Publication
Journal or Publication Title: JAMA - Journal of the American Medical Association
Volume: 305
Number: 21
Page Range: 2184 - 2192
DOI or Unique Handle: 10.1001/jama.2011.715
Schools and Programs: Graduate School of Public Health > Epidemiology
Refereed: Yes
ISSN: 0098-7484
Date Deposited: 03 Apr 2015 16:27
Last Modified: 05 Feb 2019 11:55
URI: http://d-scholarship.pitt.edu/id/eprint/24117

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