Endocrine Abstracts

Introduction: The diabetes mellitus (DM) is the known risk factor of fractures. The aim was to determine predictors of fractures in type 2 diabetic postmenopausal women without hyperparathyroidism.

Design: We analyzed local trauma clinic data for 3 sequential years from 2 662 diabetic persons who were entered The National Register of diabetes mellitus patients (133 subjects with type 1 diabetes mellitus and 1995 ones with type 2 DM). Afterward we examined 62 postmenopausal women with type 2 DM, 32 of them had bone fracture within last month. The control group included 54 non-diabetic women, 25 within a group were recently fractured. Groups were comparable in body mass index, age, duration of menopause and calcium intake. Diabetic subgroups were comparable in glycosylated hemoglobin level. None of them had hyperparathyroidism. Tests involved blood and urine calcium and phosphorus, serum parathyroid hormone (PTH), insulin-like growth factor-1 (IGF-1), 25-hydroxyvitamin D, C-terminal telopeptide of type I collagen (sCTX), osteocalcin levels and data of dual-energy X-ray absorptiometry of lumbar spine and proximal femur. For determining predictors (P<0.05) we conducted unidimensional ANOVA.

Results: In epidemiological study main risk factor of fractures was vascular complication of diabetes. Independent risk factors in cohort study were relatively low level of ionized calcium, alkaline phosphatase, phosphorus excretion, vitamin D and osteocalcin, as well as decrease of lumbar spine (L1-4) and femur (trochanter and total hip) bone mineral density.

Conclusion: Fracture risk is elevated in postmenopausal women with type 2 DM but without hyperparathyroidism in whom diabetic influence on bone turnover primary involves bone formation.

Declaration of interest: The authors declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project.

Funding: This research did not receive any specific grant from any funding agency in the public, commercial or not-for-profit sector.

Figure 1 High fracture risk algorithm for postmenopausal women with type 2 diabetes mellitus without hyperparathiroidism