Endocrine Abstracts

Introduction: Osteoporosis and diabetes are two chronic diseases with increasing prevalences, particularly among elderly. Their coexistence results in socio-economic burdens. Clinical and paraclinical assessment for fracture risk among diabetic eldery patients are necessary to implement in clinical practice. Appropriate tools shoud to be determined and tested.

Objective: To assess comorbidities and fracture risk in elderly patients having type 2 diabetes mellitus (T2DM).

Methods: A cross-sectional study was conducted between December 2020 and January 2021 among 31 patients having type 2 diabetes and aged over 65 years in the department of Endocrinology at the UHC Taher Sfar in Mahdia, Tunisia. Patients with risk factors for secondary osteoporosis weren’t included. Fracture risk of the population study patients was assessed using the FRAX tool

Results: Our population study included 16 women and 15 men having T2DM. The mean age was calculated at 69.5 ± 4.5 years. The most frequent comorbidities encountered were : overweight (26 patients), dyslipidemia (23 patients), hypertension (20 patients), osteoarthritis (21 patients), and history of (a)previous fracture(s) (8 patients). The median of A1c was situated at 9,73%. The median duration of diabetes was of 14,7 years (1–30 years). Twenty seven patients were treated with antidiabetics presenting a potential hypoglycemic risk. Chronic complications of T2DM were found among 28 patients. Bone Mineral Density (BMD) results showed osteopenia in 13 cases (41,9 %) and osteoporosis in 3 (9,7 %). Without including BMD, the Fracture risk of the population study patients assessed using the FRAX was estimated at 11.09% ± 6.28, whereas FRAX including results of the BMD estimated it at 9.91% ± 4.26. The risk of fracture using FRAX was higher in our population study without considering the results of the BMD. The BMD therefore underestimated the fracture risk in our diabetic elderly population.

Conclusion: Osteoporosis should probably be considered as a complication of diabetes rather than a comorbidity to encourage clinicians to prevent bone demineralisation and risk of falls leading to fracture specially among eldery patients. Appropriate tools should be used to detect osteopenia, osteoporosis and fracture risk among diabetic 2 patients, since having usually an associated metabolic syndrome. BMD was reported by studies underestimating osteoporosis among T2DM. FRAX tool should probably be used without including BMD to better estimate the risk of fractures the elderly diabetic population. Other contolled essays are needed and testing of new appropriate tools seems relevant.