Abstract
Diabetic patients with vertebral fractures have a higher mortality rate than people without T2DM. However, the prevalence of vertebral fracture in the Asian diabetic population is not well established. Moreover, despite an apparent increase in fracture risk in patients with diabetes, Asian countries have provided contradictory data demonstrating that bone mineral density (BMD) varies significantly in type 2 diabetes mellitus (T2DM) patients. The aim of this study was to examine and compare the prevalence of vertebral fractures and osteoporosis, as well as BMD and the FRAX score, between individuals with and without T2DM. Postmenopausal Thai women attending diabetic and health check-up clinics were recruited. BMD at the lumbar spine, total hip, and femoral neck was measured via dual-energy X-ray absorptiometry. A morphometric vertebral fracture (VF) was defined by a lateral thoracolumbar (T-L) X-ray radiograph. The Fracture Risk Assessment Tool (FRAX) was used to calculate the 10-year probabilities of hip and major osteoporotic fracture (MOF), which were calculated on the basis of the Thai FRAX model. A total of 435 participants were recruited, including 145 postmenopausal women with T2DM and 290 non-DM individuals. T2DM patients had a significantly greater BMI and BMD at the femoral neck and total hip, but there was no significant difference in the FRAX score, including the 10-year probability of hip fracture or MOF, either with or without BMD, between individuals with and without DM. The prevalence of osteoporosis in non-DM women was significantly greater at the femoral neck but comparable at the lumbar spine. Individuals with T2DM had a significantly higher rate of vertebral fractures, particularly those involving two or more levels, than those without T2DM. Diabetes was significantly associated with ≥ 2 VF, and the association remained unchanged after controlling for other clinical factors (adjusted OR = 3.72, 95% CI 1.70-8.15; p = 0.001). Our study demonstrated a greater prevalence of multiple (≥ two levels) VFs in women with T2DM than in nondiabetic controls.