Jun 2026· Karbala Journal of Pharmaceutical Sciences· Vol 17, pp. 576-586· 0 citations· 20 references
TL;DR
FRAX is significantly associated with clinical and metabolic risk factors; however, its predictive accuracy may be influenced by metabolic disturbances, especially in type 2 diabetes mellitus.
Abstract
Abstract:
Background: Osteoporosis is a chronic systemic skeletal disorder marked by a reduction in bone mineral density and structural deterioration of bone tissue, resulting in a substantially increased risk of fragility fractures.
Objective: To assess the accuracy and reliability of the FRAX tool in predicting the 10-year risk of osteoporosis-related fractures, and to determine its potential utility in guiding clinical decisions for fracture prevention and patient management.
Method: This case-control study included 100 adult women aged between 40 ≥ 60 years who had been diagnosed with osteoporosis. Participants were grouped by menopausal status (pre- and postmenopausal) and type 2 diabetes status, as well as a healthy control group, resulting in five distinct groups. Measured variables included fasting blood glucose, fasting blood insulin, and HOMA-IR. Bone mineral density (BMD) was assessed for all participants using dual-energy X-ray absorptiometry (DEXA). Additionally, the FRAX tool was employed to estimate the 10-year probability of major osteoporotic and hip fractures.
Results: Significant differences were observed among study groups in age, BMI, waist-to-hip ratio, BMD, and FRAX scores (p < 0.05). Diabetic and postmenopausal groups showed higher risks of major osteoporotic and hip fractures. Reduced BMD was significantly associated with higher HbA1c levels and increased insulin resistance. ROC analysis showed that fasting blood glucose (AUC = 0.941) and HOMA-IR (AUC = 0.879) had the highest diagnostic performance.
Conclusion: FRAX is significantly associated with clinical and metabolic risk factors; however, its predictive accuracy may be influenced by metabolic disturbances, especially in type 2 diabetes mellitus. Insulin resistance and poor glycemic control are strongly associated with reduced bone mineral density, underscoring the importance of including metabolic parameters in fracture risk assessment.
Indirect bone microarchitecture analysis using DXA-derived TBS predicts fragility fracture risk independently of spine BMD and with comparable predictive performance in postmenopausal women in Poland.
M. Warzecha, Edward Czerwiński, J. Amarowicz· Rheumatology· 0 citations
PURPOSE
Osteoporosis is highly prevalent and a major cause of fragility fractures, particularly of the spine. Adequate patient knowledge is essential for prevention, early diagnosis, and treatment adherence. This study aimed to assess osteoporosis-related knowledge in an adult population and to identify demographic and clinical factors associated with knowledge levels.
METHODS
A cross-sectional online survey was conducted within a German patient panel. Adults (≥ 18 years) who provided electronic consent were included. Osteoporosis knowledge was assessed using the validated Osteoporosis Knowledge Assessment Tool (OKAT) and Facts on Osteoporosis Quiz (FOOQ). Osteoporosis risk was descriptively evaluated using the IOF One-Minute Osteoporosis Risk Test. Participants were stratified into three age groups (< 50, 50-65, > 65 years). Group comparisons were performed using Mann-Whitney U tests; associations were analyzed using Spearman correlations. Additionally, multivariable linear regression analyses were performed.
RESULTS
A total of 315 participants were included (mean age 61.6 ± 12.0 years; 74.3% female). IOF risk scores increased significantly with age. Bivariate analyses demonstrated significantly higher knowledge in participants < 50 years compared to older groups, but this age association was no longer observed after multivariable adjustment. Women scored higher than men on the FOOQ but not on the OKAT. Higher educational attainment and employment in the medical field were significantly associated with higher knowledge scores. Neither personal diagnosis nor family history of osteoporosis was associated with increased knowledge. IOF risk scores showed a weak negative correlation with FOOQ scores.
CONCLUSION
Educational level emerged as an important correlate of osteoporosis knowledge in this exploratory analysis, whereas personal or familial disease experience did not improve understanding. These findings highlight a relevant gap in osteoporosis education and support the need for future targeted educational interventions, including in patient populations at risk for vertebral fragility fractures.
Anna-Lena Hauser, J.F. Noriega Urena, Tobias Lange et al.· European spine journal· 0 citations
There is no unified approach to screening for high fracture risk in international practice.
Objective
: to evaluate the efficacy of a population-based screening program for osteoporosis and high fracture risk using the FRAX tool in postmenopausal women and men aged 40 years and older in real-world primary healthcare practice.
Material and methods
. A single-center prospective case-control cohort study included 34,357 individuals aged 40 years and older. In the screening group (n=10,743), primary care physicians assessed the 10-year probability of fractures using the FRAX calculator in 2018. High fracture risk was defined as exceeding the Russian FRAX intervention threshold and/or having a history of a low-energy fracture. The control group consisted of unscreened individuals (n=23,614). Screening efficacy was assessed based on changes in the incidence of osteoporotic fractures during 3 years of follow-up (2019–2021).
Results and discussion
. High fracture risk was identified in 16.8% of patients in the screening group. In this group, the incidence of all fractures decreased by 33.8% (from 21.0 to 13.9 per 1,000 population; p<0.001), whereas in the control group this indicator increased by 26.7% (from 8.6 to 10.9 per 1,000; p=0.012). In the subgroup of high-risk patients who received treatment, fracture incidence decreased 3.1-fold (p<0.001).
Conclusion
. Screening based on FRAX and a history of previous fractures is an effective strategy for reducing fracture rates in real-world clinical practice and may therefore be recommended for widespread use in primary healthcare.
E. Gladkova, V. Tanaev, D. A. Shimanski et al.· Modern Rheumatology Journal· 0 citations
Osteoporosis is the most prevalent metabolic bone disease and is associated with an increased risk of fragility fractures. Current guidelines recommend bone mineral density (BMD) assessment by DXA primarily in women aged ≥65 years or in younger women with clinical risk factors. However, DXA is frequently performed in women under 65 years without guideline-based indications. Objective: To describe the prevalence of densitometric osteoporosis in women under 65 years undergoing DXA in the absence of clinical risk factors. Methods: A descriptive cross-sectional study was conducted at a referral center. Women aged 40–65 years consecutively referred for DXA between February and September 2024 were included. Participants with FRAX® clinical risk factors, major osteoporotic fractures, secondary metabolic bone diseases, or dietary restrictions were excluded. BMD was assessed at the lumbar spine, total hip, and femoral neck. Osteoporosis was defined as a T-score ≤ -2.5. Results: A total of 119 women were included (mean age 53 years; range 43-62). Mean T-scores were -0.9±1.3 at the lumbar spine, -0.9±1.1 at the total hip, and -1.0±1.0 at the femoral neck. BMD values within the osteoporotic range was observed in 13% (n=15) at the lumbar spine and in 7% (n=8) at both the total hip and femoral neck. Overall, 17% (n=20) had BMD values within the osteoporotic range at at least one skeletal site. Conclusion: Densitometric osteoporosis was identified in a relevant proportion of women younger than 65 years without traditional risk factors, supporting an individualized approach to bone health assessment.
Josefina Rosmino, M. Pavlove, M. L. Brance et al.· EndoAr· 0 citations
Objective: This study aimed to evaluate the relationship between vertebral fracture and various biological factors in patients with type 1 diabetes mellitus (T1DM).
Methods: The study included 61 patients diagnosed with T1DM who were evaluated in the Diabetes Outpatient Clinic between 2017 and 2019, and 49 healthy individuals forming the control group. Demographic and clinical characteristics (age, gender, hypertension, hyperlipidemia, obesity), biochemical parameters (fasting blood glucose, HbA1c, calcium, phosphate, parathyroid hormone, 25-OH vitamin D, C-terminal telopeptide, osteocalcin, alkaline phosphatase), and bone-related variables (L1–L4 and femoral neck bone mineral density [BMD], vertebral fracture status) were comprehensively collected during outpatient visits. Vertebral fractures were assessed by the Genant semi-quantitative method using lateral vertebral fracture assessment images obtained by dual-energy X-ray absorptiometry. Data were analyzed using non-parametric statistical tests and expressed as median (interquartile range). Logistic regression analysis adjusted for age, sex, body mass index (BMI), and phosphate levels was performed.
Results: Vertebral fracture prevalence was significantly higher in T1DM patients (67.2%) compared with controls (26.5%, P < .001). Patients had significantly lower body weight and BMI and higher rates of hyperlipidemia. Femoral neck BMD was significantly lower in the T1DM group (0.967 vs. 1.193 g/cm2, P < .001). Among diabetic patients, those with vertebral fractures had significantly lower serum phosphate levels than those without fractures (3.20 vs. 3.85 mg/dL, P = .008). No significant differences were observed in bone turnover markers or BMD values between patients with and without fractures.
Conclusion: Type 1 diabetes mellitus patients showed a markedly higher prevalence of vertebral fractures and lower femoral neck BMD compared with healthy controls. Lower phosphate levels were observed in patients with fractures, suggesting a potential role of phosphate metabolism in diabetic bone fragility.
Cite this article as: Günhan HG, .etin O, İmre E, Gogas Yavuz D. Bone mineral density and vertebral fracture frequency in a group of type 1 diabetic patients. Cerrahpaşa Med J. 2026, 50, 0091, doi: 10.5152/cjm.2026.25091.
Hatice Gizem Günhan, Okan Çetin, Eren İmredrg et al.· Cerrahpasa Medical Journal· 0 citations
The study indicates that lower BHI SDS values are associated with increased fracture risk in children with classical OI and indicates that BHI may represent a clinically useful complementary tool for fracture risk stratification in young children with OI, particularly where DXA is unavailable or technically limited, including infancy.
Ruggero Lanzafame, Alistair D Calder, B. Crowe et al.· Journal of Clinical Endocrin...· 0 citations
