Increased prevalence of minimal trauma fractures in patients with diabetes mellitus: a tertiary centre experience — ASN Events
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Increased prevalence of minimal trauma fractures in patients with diabetes mellitus: a tertiary centre experience (#213)

Eleanor P Thong 1 2 , Philip Wong 1 3 , Hikaru Hashimura 4 , Peter R Ebeling 1 5 , Helena J Teede 1 2 , Frances Milat 1 3
  1. Dept of Endocrinology, Monash Health, Clayton, VIC, Australia
  2. Monash Centre for Health Research & Implementation, Melbourne, VIC, Australia
  3. Hudson Institute of Medical Research, Clayton, VIC, Australia
  4. Dept of Endocrinology and Diabetes, Monash Health, Clayton, VIC, Australia
  5. Dept of Medicine, Monash Health, Clayton, VIC, Australia

AIM: To investigate the prevalence of minimal trauma fractures (MTFs) in osteoporotic or osteopaenic patients referred to a tertiary centre, with or without diabetes mellitus.

DESIGN: A retrospective cross-sectional study was performed on 3653 patients referred for dual-energy X-ray absorptiometry (DXA), at Monash Medical Centre over 18 months (February 2012-August 2013).  Adults with osteoporosis or osteopenia, confirmed on DXA or a history of fragility fracture, were eligible. Patients with other secondary causes of osteoporosis were excluded. MTFs were confirmed radiologically or identified through medical records. Logistic regression analyses were performed to adjust for confounding factors for fractures.

RESULTS: 222 non-diabetic and 62 diabetic patients with osteoporosis or osteopenia were included. Mean ages of patients in the diabetic and non-diabetic groups were similar (67.1±12.2 years vs.66.7±12.8 years, p=0.81). There was a female preponderance in both groups (82.9% vs. 75.3%, p=0.17). Body mass index was higher in the diabetic group (30.5±8.6 vs 26.9±6.4, p<0.001). There were no significant differences in the spine or hip bone mineral density (BMD) in both groups.

Patients with diabetes had a significantly higher prevalence of MTFs (67.1% vs. 46.4%, p<0.01; OR 2.36, 95% CI 1.35-4.11, p<0.01) compared with those without diabetes, which remained significant after adjustment for age, gender, weight and BMD (OR 2.38, 95% CI 1.21-3.78, p=0.02). Additionally, the prevalence of multiple MTFs was higher in the diabetic group (20.5% vs. 9.9%, p=0.02; OR 2.35, 95%CI 1.15-4.82, p=0.02).  Patients with Type 1 diabetes (n=11) had a higher prevalence of MTFs (100% vs. 61.3%, p=0.01) than those with Type 2 diabetes (n=62) [Supplementary table 1].

CONCLUSION: In patients referred for bone densitometry, diabetes is an independent risk factor for fractures. Patients with diabetes are also more likely to have multiple MTFs. Further studies are needed to elucidate the mechanism underlying bone fragility and fracture risk in diabetes. 

 

Supplementary table 1

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