Research Article | | Peer-Reviewed

Risk Factors for Ten-Year Risk of Osteoporosis in Type 2 DM Patients Attending Tikur Anbessa Specialized Hospital Diabetic Center Cross-sectional Study

Received: 15 May 2024     Accepted: 23 May 2024     Published: 6 June 2024
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Abstract

Background: Type 2 diabetes mellitus (T2DM) is a major contributing factor to osteoporotic fractures via different mechanisms. This study assessed the ten-year risk of osteoporosis and associated factors for osteoporotic fractures in T2DM patients. Methods: Data from 175 type diabetes mellites (T2DM) patients over 40 years attending a diabetes clinic at Tikur Anbessa Specialized Hospital (TASH) were collected. Demographic information, diabetic complications, blood sugar levels, and other medical illnesses were collected by a structured questionnaire and from an electronic medical record system. The 10-year fracture risk assessment (FRAX) tool was used without bone mineral density (BMD) measurement. multivariate logistic regression was used to analyze factors associated with fragility fractures. Results: Half the participants were female, with a median age of 60. Most were married, well-educated, and urban residents. The median duration of diabetes was 11 years. The median FRAX score indicated a moderate 10-year risk of hip fracture (≥3%) and a high risk of major osteoporotic fracture (≥20%). Overall, 30.9% of patients had a high 10-year risk of osteoporotic fracture. The majority (78.3%) had macrovascular complications, with neuropathy, retinopathy, and nephropathy being the common ones. Higher FBS, higher HbA1c, and the presence of macrovascular complications were significantly associated with a higher risk of fractures. Conclusion: This study found a high prevalence (30.9%) of a 10-year risk of osteoporotic fractures in T2 DM patients. Poor glycemic control (higher HbA1c and FBS) and the presence of macrovascular complications were significantly associated with an increased 10-year osteoporotic fracture risk.

Published in International Journal of Diabetes and Endocrinology (Volume 9, Issue 2)
DOI 10.11648/j.ijde.20240902.13
Page(s) 46-55
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Osteoporosis, DM, Fragility Fracture, FRAX Tool, Diabetic Complication

1. Introduction
Globally, an estimated 151 million people live with type 2 DM, and by 2030this number is expected to rise to 324 million—type 2 DM results in many harmful complications, cardiovascular and renal complications being the most common. Several factors increase the risk of falls in type 2 DM patients, which include diabetic foot ulcer, diabetic peripheral neuropathy, diabetic retinopathy, and autonomic disturbances like orthostatic hypotension .
A large-scale meta-analysis published in 2020 investigated the association between type 2 diabetes mellitus (T2DM) and fracture risk, encompassing over 17.5 million participants from cohort and case-control studies. The findings reinforce the link between T2DM and an increased risk of fractures, particularly hip fractures. The analysis revealed a significant increase in hip fracture risk for individuals with T2DM. Compared to controls, men with T2DM exhibited a 13% greater risk, while women with T2DM showed a 34% increase in hip fracture risk. The study also identified a 19% rise in the risk of nonvertebral fractures (e.g., spine or wrist) among individuals with T2DM compared to the non-diabetic group. Notably, the analysis suggests that the heightened fracture risk in T2DM patients might be influenced by specific T2DM-related risk factors, potentially explaining variations in risk across the entire T2DM population .
A well-established risk factor for fractures is low bone mineral density (BMD) . However, individuals with type 2 diabetes (T2DM) often have higher than expected BMD, potentially due to insulin resistance. Despite this higher BMD, T2DM patients experience fractures at a greater rate compared to those without diabetes. This suggests alternative mechanisms contributing to bone fragility in this population .
The FRAX tool, a commonly used method for fracture risk assessment, might underestimate the elevated risk of osteoporotic fracture in T2DM patients. This highlights the need to incorporate additional factors into this group's fracture risk prediction .
Elevated glycation of bone matrix proteins in type 2 diabetes mellitus patients might be a factor leading to their increased risk of fractures .
Studies have also shown an association between fracture risk and diabetes treatment, such as insulin and thiazolidinedione use . However, due to the interactions among medication, glycemic control, and diabetes-associated comorbidities, the relative effects of each factor still need to be determined
Diabetes-associated complications, including peripheral neuropathy and congestive heart failure, were found to play a significant role in fracture risk .
A U-shaped relationship exists between HbA1c and fracture risk; HbA1c levels between 6.5% and 6.9% are associated with the lowest risk of fragility fractures. Conversely, HbA1c levels equal to or exceeding 9% were linked to an increased risk of fragility fractures. Interestingly, this could potentially indicate infrequent patient-provider interaction, as patients with uncontrolled diabetes might be less likely to receive regular healthcare .
2. Methods
2.1. Study Design
An institution-based cross-sectional study assessed the risk of high-risk fractures and associated factors in type 2 DM patients at Tikur Anbessa specialized hospital diabetic center from February 2023 to February 2024. The study included type 2 DM patients above the age of 40. Patients with one or more of the following were excluded from the study. 1) Individuals with active malignancy, 2) Type1 DM, 3) individuals taking anticoagulation therapy, 4) individuals with ESRD other than diabetic nephropathy, and 5) those who are <40 years old.
2.2. Study Procedure
A structured questionnaire was used to collect socio-demographic data, smoking, alcohol use, Parental history of hip fracture, awareness about osteoporosis, usage of vitamin supplements and calcium supplements, a diet rich in vitamin D and calcium, frequency of fall-down accidents in the past year, bone pain use of glucocorticoids and other risk factors for osteoporosis.
Laboratory data and macrovascular and microvascular complications were obtained from the electronic record system.
2.3. Sampling Procedure
All eligible patients with complete data were involved in the study.
2.4. Statistical Analysis
The quality of their data was ensured by verifying its completeness and consistency through cross-checking. The Kobo toolbox was used to enter and manage data. After extraction, the data was analyzed using SPSS version 26 software. A p-value of less than 0.05 was considered statistically significant. First, binary regression was used to identify factors linked to osteoporosis. Subsequently, a multiple logistic regression model included variables with a p-value less than 0.25 in the initial analysis for further evaluation.
3. Results
3.1. Sociodemographic Characteristics
The study included a total of 175 patients. Out of this, 88 (50.3%) were females, and the median (IQR) age was 60 (52-66) years. 134 (76.6%) were Orthodox Christians and 20 (11.4%) were Muslims. Most patients (74.3%) were married, and 78 (44.6%) had attended college and above. Most patients (85.1%) were from Addis Ababa, and almost all (97.1) lived in an urban setup. 68 (38.9%) were government employees, and the median monthly income of the participants was 5000 (3000-8000) ETB. (Table 1)
Table 1. Sociodemographic characteristics of patients.

N

%

Median (IQR)

Sex

Male

87

49.7

Female

88

50.3

Age (years)

60 (52-66)

Educational level

Unable to read and write

4

2.3

Able to read and write

10

5.7

Primary education

30

17.1

High school

53

30.3

College and above

78

44.6

Residence

Rural

5

2.9

Urban

170

97.1

Address

Addis Ababa

149

85.1

SNNPR

2

1.1

Amhara

1

0.6

Harare

1

0.6

Oromia

22

12.6

Occupation

Daily laborer

2

1.1

Farmer

2

1.1

Government employee

68

38.9

Housewife

50

28.6

Merchant

8

4.6

Self-employed

45

25.7

Monthly income (ETB)

5000 (3000-8000)

3.2. Diabetes Profile of Patients
The median (IQR) duration of diabetes among participants was 11 (6-20) years. The median (IQR) levels of HgA1c and FBS were 8.0 (7.0-9.4) and 150 (125-192), respectively. Macrovascular complications occurred in 137 (78.3%) patients, while neuropathy, retinopathy, and nephropathy were seen in 143 (81.7%), 140 (80.0%), and 126 (72.0%) patients, respectively.
Table 2. Diabetes profile of patients.

Median (IQR)

N

%

Duration of DM (years) - median (IQR)

11 (6-20)

Degree of control HgA1c

8.0 (7.0-9.4)

Degree of glycemic control /FBS

150 (125-192)

Macrovascular complications

No

137

78.3

Yes

38

21.7

Neuropathy

No

143

81.7

Yes

32

18.3

Nephropathy

No

126

72.0

Yes

49

28.0

Retinopathy

No

140

80.0

Yes

35

20.0

3.3. Risk Factors for Ten Years Risk of Osteoporosis
The most common risk factors identified were drinking alcohol, personal history of fracture, family history of hip fracture, and cigarette smoking seen in 115 (65.7%), 113 (64.6%), 110 (62.9%) and 17 (9.7%) patients, respectively. 151 (86.3%) patients took milk, cheese, or yogurt, while 42 (24.0%) used vitamin supplements. The median (IQR) weight and height were 71 (63-80) kilograms and 1.65 (1.58-.70) meters, respectively.
3.4. Risk Factors for Fracture
124 (70.9%) patients had a history of fall accidents in the past year, whereas 74 (42.3%) complained of difficulty keeping their balance. 71 (40.6%) had trouble with their vision, and 18 (10.3%) thought the lighting condition in their living and bathrooms was poor. History of bone pain and arrhythmia was elicited in 57 (32.6%) and 5 (2.9%) patients, respectively.
Table 3. Risk factors for osteoporosis.

Variables

N

%

Median (IQR)

Alcohol intake≥3 units/day

No

60

34.3

Yes

115

65.7

Active Cigarette smoking

No

158

90.3

Yes

17

9.7

Vitamin supplement intake

No

133

76.0

Yes

42

24.0

Calcium supplement intake

No

155

88.6

Yes

20

11.4

Hormonal supplement intake

No

175

100.0

Yes

0

0.0

Milk, cheese, or yogurt intake

No

24

13.7

Yes

151

86.3

Family history of hip fracture (father or mother)

No

65

37.1

Yes

110

62.9

Epilepsy

No

171

97.7

Yes

4

2.3

Stroke

No

167

95.4

Yes

8

4.6

RA

No

173

98.9

Yes

2

1.1

SLE

No

175

100.0

Yes

0

0.0

Spinal cord injury

No

175

100.0

Yes

0

0.0

Malabsorption

No

174

99.4

Yes

1

0.6

IBD

No

174

99.4

Yes

1

0.6

Cirrhosis

No

173

98.9

Yes

2

1.1

Glucocorticoid intake

No

172

98.3

Yes

3

1.7

Previous history of fracture

No

62

35.4

Yes

113

64.6

Weight (Kg)

71 (63-80)

Height (M)

1.65 (1.58-.70)

Table 4. Risk factors for falls and fractures.

Variables

N

%

Fall accident in the past year.

No

51

29.1

Yes

124

70.9

Difficulty of keeping balance

No

101

57.7

Yes

74

42.3

Difficult in vision

No

104

59.4

Yes

71

40.6

Condition of lighting in living and bathrooms

Poor

18

10.3

Good

157

89.7

History of arrhythmia

No

170

97.1

Yes

5

2.9

History of bone pain

No

118

67.4

Yes

57

32.6

Multiple myeloma

No

175

100.0

Yes

0

0.0

3.5. Knowledge About Osteoporosis (Bone Thinning)
61 (34.9%) patients knew about bone thinning, and 40 (22.9%) patients knew that T2DM is related to bone thinning. Only 22 (12.6%) patients were screened for osteoporosis, out of which 12 (54.5%) received treatment. 77 (44%) patients knew the importance of osteoporosis screening.
Table 5. Knowledge about osteoporosis.

Variables

N

%

Know about osteoporosis (bone thinning)

No

114

65.1

Yes

61

34.9

Screened for osteoporosis (bone thinning)

No

153

87.4

Yes

22

12.6

Know the importance of osteoporosis (bone thinning) screening

No

98

56.0

Yes

77

44.0

Know that T2DM is related to osteoporosis (bone thinning)

No

135

77.1

Yes

40

22.9

3.6. Prevalence of 10-Year Risk of Osteoporosis
The median (IQR) FRAX score for the 10-year probability of a hip fracture ≥ 3% and a 10-year probability of a major osteoporosis-related fracture ≥ 20% were 1.5 (0.5-3.3) and 7.8 (3.0-10.0), respectively. Using the FRAX score for the 10-year probability of a hip fracture, 54 (30.9%) patients had a 10-year risk of osteoporosis. However, only 8 (4.8%) had an increased risk of 10-year risk of osteoporosis using the FRAX score for the 10-year probability of a major osteoporosis-related fracture, and all had a 10-year probability of a hip fracture of ≥3%. Accordingly, the overall prevalence of a 10-year risk of osteoporosis in this study is 30.9%.
3.7. Factors Associated with Ten-Year Risk of Osteoporosis
Upon binary regression, monthly income ≤5000 ETB, longer duration of DM, higher FBS, higher HgA1c, and the presence of macrovascular complications, diabetic nephropathy, diabetic neuropathy, and diabetic retinopathy were associated with using a P-value of 0.25 as a cutoff. These variables were then taken to multivariate logistic regression, after which only three variables were found to have a statistically significant association with increased risk of 10-year osteoporosis. These variables were higher FBS (AOR, 1.01; 95% CI, 1.00-1.02; P= 0.011), higher HgA1c (AOR, 1.45; 95% CI, 1.11-1.88; P= 0.006), and presence of macrovascular complications (AOR, 2.73; 95% CI, 1.12-6.66; P= 0.027).
Table 6. Factors associated with ten-year risk of osteoporosis.

Variables

Osteoporosis

COR (5% CI)

AOR (5% CI)

P value

No

Yes

Monthly income (ETB)

≤5K

69

36

1.00

1.00

>5K

52

18

0.66 (0.34-1.30)

0.54 (0.24-1.21)

0.134

Duration of DM (years) – median (IQR)

10 (5-18)

15 (9-21)

1.05 (1.01-1.09)

1.02 (0.98-1.07)

0.397

FBS (mg/dL) – median (IQR)

138 (118-160)

189 (155-240)

1.02 (1.01-1.03)

1.01 (1.00-1.02)

0.011*

HgA1c (%) – median (IQR)

7.6 (6.9-8.8)

9.3 (8.5-10.3)

1.78 (1.42-2.23)

1.45 (1.11-1.88)

0.006*

Nephropathy

No

91

35

1.00

1.00

Yes

30

19

1.65 (0.82-3.30)

0.86 (0.36-2.05)

0.730

Neuropathy

No

102

41

1.00

1.00

Yes

19

13

1.70 (0.77-3.76)

1.11 (0.42-2.91)

0.835

Retinopathy

No

101

39

1.00

1.00

Yes

20

15

1.94 (0.90-4.17)

1.55 (0.61-3.92)

0.353

Macrovascular complications

No

102

35

1.00

1.00

Yes

19

19

2.91 (1.39-6.13)

2.73 (1.12-6.66)

0.027*

*Statistically significant
4. Discussion
This study identified a 30.9% prevalence rate for a 10-year risk of osteoporosis.
The diagnosis of osteoporosis is based on BMD measurements or clinically by the presence of a fragility fracture; multiple studies showed an association between type 2 DM and the risk of osteoporotic fractures but showed mixed outcomes . Some studies have shown a surprisingly lower prevalence of osteoporosis, as measured by bone mineral density (BMD), in patients with type 2 diabetes compared to healthy controls . One potential explanation for this unexpected finding could be the presence of degenerative changes and diffuse idiopathic skeletal hyperostosis (DISH), which are frequently observed in patients with type 2 diabetes . In contrast, a systematic review conducted in China found a greater prevalence of osteoporosis among individuals with type 2 diabetes mellitus (T2DM) .
Our study participants' median age (IQR) was 60 (52-66) years, consistent with different metanalysis. Our result showed no association between fragility fracture with age and sex, suggesting that type DM might play a vital role in both sexes and across different age groups; this finding is also seen in other meta-analyses .
Our study showed a strong association between the degree of glycemic control (HGA1C and fasting blood sugar) and increased risk of fragility fractures, FBS (AOR, 1.01; 95% CI, 1.00-1.02; P= 0.011), HgA1c (AOR, 1.45; 95% CI, 1.11-1.88; P= 0.006). This finding is consistent with different studies; Conway et al. revealed a complex relationship between HbA1c levels and the risk of osteoporosis-related fractures. This relationship was described as cubic, meaning that both very low and very high HbA1c levels were associated with increased fracture risk, as opposed to a simple linear relationship where only high HbA1c would be a risk factor .
A meta-analysis by Lin et al. found a strong link between HbA1c and osteoporosis risk. Individuals with HbA1c levels equal to or above 7 had a significantly increased risk of osteoporosis compared to those with HbA1c below 7. This translates to an adjusted hazard ratio (HR) of 1.49, with a 95% confidence interval (CI) ranging from 1.15 to 1.92 (p = 0.002) . Krakauer JC et al. also found that poor glycemic control metabolic effects led to increased bone resorption and bone loss in young adults .
Li CI et al. found an increasing trend between the HbA1c level and hip fracture incidence in individuals with type 2 DM above 65 years. The risk of hip fracture was 24%–31% higher among patients with HbA1c levels ≥ 9% than among patients with HbA1c levels of 6%–7% after adjusting for numerous risk factors for fracture .
A study investigated bone mineral density (BMD) in 78 poorly controlled type 2 diabetes patients (T2DM) aged 28-73 with initial HbA1c exceeding 8%. The patients underwent BMD measurements before and after three weeks of improved glycemic control. The study found that better blood sugar control decreased bone mineral loss within this short period. This suggests that managing blood sugar levels in T2DM patients might play a role in protecting against bone loss
Macrovascular complications such as ischemic heart disease, peripheral arterial diseases, and cerebrovascular diseases were found to be significantly associated with increased fragility fractures and osteoporosis in our study.
Macrovascular complications occurred in 137 (78.3%) patients, while neuropathy, retinopathy, and nephropathy were seen in 143 (81.7%), 140 (80.0%), and 126 (72.0%) patients, respectively. A statistically significant association between macrovascular complications and risk of osteoporosis was seen (AOR, 2.73; 95% CI, 1.12-6.66; P= 0.027).
These findings agreed with findings from different studies. A retrospective study by Lee et al. examined the link between diabetes and fracture risk. After accounting for various factors like age, ethnicity, and medical conditions, the study found that Individuals with diabetes had an approximately 22% increased risk of any clinical fracture compared to those without diabetes (adjusted risk ratio: 1.22, 95% CI: 1.21-1.23). Similarly, the risk of hip fracture was also about 21% higher in diabetic patients (adjusted risk ratio: 1.21, 95% CI: 1.19-1.23). Crucially, the study identified specific health conditions that might explain a significant portion of this increased fracture risk in diabetic patients. These mediating factors were Peripheral neuropathy, cardiovascular disease, and Congestive heart failure. These three conditions together accounted for 45.5% of the fracture risk associated with diabetes.
Although other studies indicated a correlation between microvascular complications and an increased risk of osteoporosis . In this study, we did not find a significant association between microvascular complications and the risk of fragility fracture and osteoporosis. Diabetic retinopathy (AOR, 1.00; 1.55 (0.61-3.92, p=0.353), diabetic nephropathy (AOR, 1.00; 0.86 (0.36-2.05; p=0.730) and diabetic peripheral neuropathy (AOR, 1.00; 1.11 (0.42-2.91; p=0.835). This discrepancy might be explained by the effects of treatments to control microvascular complications, although further investigation is needed.
To our knowledge, this is the first study in our country focusing on the prevalence of osteoporosis in type 2 DM patients and associated risk factors. Despite the lack of materials to do BMD in our setup, the study tried to estimate the risk of fragility fracture.
Limitations of the study: Since the study was done in a single center and most participants were urban dwellers, it is challenging to generalize the result for the general population.
The unavailability of the DEXA scan in our center for BMD measurements limited our ability to exclude potential confounding factors. FRAX score without BMD risk calculation may underestimate the risk of osteoporosis and fragility fractures. Recall bias also might be a factor.
5. Conclusion
The prevalence of a 10-year risk of osteoporosis was 30.9% in this study. Levels of HGA1C, FBS, and macrovascular complications were significantly associated with the risk of fragility fractures and osteoporosis.
Abbreviations

AOR

Adjusted Odds Ratio

BMD

Bone Mineral Density

CD

Crohn's Disease

CHF

Congestive Heart Failure

CI

Confidence Interval

CVD

Cerebrovascular Disease

DISH

Diffuse Idiopathic Skeletal Hyperostosis

DM

Diabetes Mellitus

ETB

Ethiopian Birr

FBS

Fasting Blood Sugar

FRAX

Fracture Risk Assessment Tool

HbA1c

Hemoglobin A1c

HIV

Human Immunodeficiency Virus

IBD

Inflammatory Bowel Disease

IHD

Ischemic Heart Disease

IQR

Interquartile Range

MOF

Major Osteoporotic Fracture

PAD

Peripheral Arterial Disease

RA

Rheumatoid Arthritis

SLE

Systemic Lupus Erythematosus

T1DM

Type 1 DM

T2DM

Type 2 DM

UC

Ulcerative Colitis

Acknowledgments
Not applicable.
Author Contributions
Gebeyehu Azibte: Conceptualization, Methodology, Investigation, Analysis, and manuscript Writing.
Zekarias Ayalew: Conceptualization, Methodology, Investigation, Analysis, and manuscript writing.
Kibrekidusan Tsige: Conceptualization, Methodology, Investigation, Analysis, and manuscript writing.
Bereket Molla: Methodology, Data curation, Drafting, Interpretation, and Edition of the data, supervision, and manuscript edition.
Mahlet Weldeamanuel: Methodology, Data curation, Drafting, Interpretation, and Edition of the data, supervision, and manuscript edition.
Waltengus Birhanu: Methodology, Data curation, Drafting, Interpretation, and Edition of the data, supervision, and manuscript edition.
Biruk Legesse: Methodology, Data curation, Drafting, Interpretation, and Edition of the data, supervision, and manuscript edition.
Funding
This research received no external funding.
Institutional Review Board Statement
The study was conducted by the Declaration of Helsinki and approved by the Institutional Review Board of Addis Ababa University, College of Health Sciences.
Informed Consent Statement
Informed consent was obtained from all subjects involved in the study.
Consent for Publication
Not applicable.
Data Availability Statement
The authors confirm that the data supporting the findings of this study are available within the article.
Conflicts of Interest
The authors declare no conflicts of interest.
References
[1] Axelsson KF, Litsne H, Kousoula K, Franzén S, Eliasson B, Lorentzon M. Risk of fracture in adults with type 2 diabetes in Sweden: A national cohort study. PLoS Med. 2023; 20(1): e1004172.
[2] Vilaca T, Schini M, Harnan S, Sutton A, Poku E, Allen IE, et al. The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: A systematic review and meta-analysis update. Bone. 2020; 137: 115457.
[3] Center JR, Nguyen TV, Schneider D, Sambrook PN, Eisman JA. Mortality after all major types of osteoporotic fracture in men and women: an observational study. Lancet. 1999; 353(9156): 878-82.
[4] Schwartz AV, Vittinghoff E, Bauer DC, Hillier TA, Strotmeyer ES, Ensrud KE, et al. Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. Jama. 2011; 305(21): 2184-92.
[5] Kanis JA, Harvey NC, Johansson H, Liu E, Vandenput L, Lorentzon M, et al. A decade of FRAX: how has it changed the management of osteoporosis? Aging Clin Exp Res. 2020; 32(2): 187-96.
[6] Khosla S, Samakkarnthai P, Monroe DG, Farr JN. Update on the pathogenesis and treatment of skeletal fragility in type 2 diabetes mellitus. Nat Rev Endocrinol. 2021; 17(11): 685-97.
[7] Nilsson AG, Sundh D, Johansson L, Nilsson M, Mellström D, Rudäng R, et al. Type 2 Diabetes Mellitus Is Associated With Better Bone Microarchitecture But Lower Bone Material Strength and Poorer Physical Function in Elderly Women: A Population-Based Study. J Bone Miner Res. 2017; 32(5): 1062-71.
[8] Losada E, Soldevila B, Ali MS, Martínez-Laguna D, Nogués X, Puig-Domingo M, et al. Real-world antidiabetic drug use and fracture risk in 12,277 patients with type 2 diabetes mellitus: a nested case-control study. Osteoporos Int. 2018; 29(9): 2079-86.
[9] Driessen JH, van Onzenoort HA, Henry RM, Lalmohamed A, van den Bergh JP, Neef C, et al. Use of dipeptidyl peptidase-4 inhibitors for type 2 diabetes mellitus and risk of fracture. Bone. 2014; 68: 124-30.
[10] Lee RH, Sloane R, Pieper C, Lyles KW, Adler RA, Van Houtven C, et al. Glycemic Control and Insulin Treatment Alter Fracture Risk in Older Men With Type 2 Diabetes Mellitus. J Bone Miner Res. 2019; 34(11): 2045-51.
[11] Lee RH, Sloane R, Pieper C, Lyles KW, Adler RA, Van Houtven C, et al. Clinical Fractures Among Older Men With Diabetes Are Mediated by Diabetic Complications. J Clin Endocrinol Metab. 2018; 103(1): 281-7.
[12] Conway BN, Long DM, Figaro MK, May ME. Glycemic control and fracture risk in elderly patients with diabetes. Diabetes Res Clin Pract. 2016; 115: 47-53.
[13] Lin HH, Hsu HY, Tsai MC, Hsu LY, Chien KL, Yeh TL. Association between type 2 diabetes and osteoporosis risk: A representative cohort study in Taiwan. PLoS One. 2021; 16(7): e0254451.
[14] Bai J, Gao Q, Wang C, Dai J. Diabetes mellitus and risk of low-energy fracture: a meta-analysis. Aging Clin Exp Res. 2020; 32(11): 2173-86.
[15] Fan Y, Wei F, Lang Y, Liu Y. Diabetes mellitus and risk of hip fractures: a meta-analysis. Osteoporos Int. 2016; 27(1): 219-28.
[16] Koromani F, Oei L, Shevroja E, Trajanoska K, Schoufour J, Muka T, et al. Vertebral Fractures in Individuals With Type 2 Diabetes: More Than Skeletal Complications Alone. Diabetes Care. 2020; 43(1): 137-44.
[17] Picke AK, Campbell G, Napoli N, Hofbauer LC, Rauner M. Update on the impact of type 2 diabetes mellitus on bone metabolism and material properties. Endocr Connect. 2019; 8(3): R55-r70.
[18] Gilbert MP, Pratley RE. The impact of diabetes and diabetes medications on bone health. Endocr Rev. 2015; 36(2): 194-213.
[19] Leidig-Bruckner G, Grobholz S, Bruckner T, Scheidt-Nave C, Nawroth P, Schneider JG. Prevalence and determinants of osteoporosis in patients with type 1 and type 2 diabetes mellitus. BMC Endocr Disord. 2014; 14: 33.
[20] Sencan D, Elden H, Nacitarhan V, Sencan M, Kaptanoglu E. The prevalence of diffuse idiopathic skeletal hyperostosis in patients with diabetes mellitus. Rheumatol Int. 2005; 25(7): 518-21.
[21] Si Y, Wang C, Guo Y, Xu G, Ma Y. Prevalence of Osteoporosis in Patients with Type 2 Diabetes Mellitus in the Chinese Mainland: A Systematic Review and Meta-Analysis. Iran J Public Health. 2019; 48(7): 1203-14.
[22] Krakauer JC, McKenna MJ, Buderer NF, Rao DS, Whitehouse FW, Parfitt AM. Bone loss and bone turnover in diabetes. Diabetes. 1995; 44(7): 775-82.
[23] Li CI, Liu CS, Lin WY, Meng NH, Chen CC, Yang SY, et al. Glycated Hemoglobin Level and Risk of Hip Fracture in Older People with Type 2 Diabetes: A Competing Risk Analysis of Taiwan Diabetes Cohort Study. J Bone Miner Res. 2015; 30(7): 1338-46.
[24] Okazaki R, Totsuka Y, Hamano K, Ajima M, Miura M, Hirota Y, et al. Metabolic improvement of poorly controlled noninsulin-dependent diabetes mellitus decreases bone turnover. J Clin Endocrinol Metab. 1997; 82(9): 2915-20.
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    Azibte, G., Ayalew, Z., Tsige, K., Molla, B., Weldeamanuel, M., et al. (2024). Risk Factors for Ten-Year Risk of Osteoporosis in Type 2 DM Patients Attending Tikur Anbessa Specialized Hospital Diabetic Center Cross-sectional Study. International Journal of Diabetes and Endocrinology, 9(2), 46-55. https://doi.org/10.11648/j.ijde.20240902.13

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    ACS Style

    Azibte, G.; Ayalew, Z.; Tsige, K.; Molla, B.; Weldeamanuel, M., et al. Risk Factors for Ten-Year Risk of Osteoporosis in Type 2 DM Patients Attending Tikur Anbessa Specialized Hospital Diabetic Center Cross-sectional Study. Int. J. Diabetes Endocrinol. 2024, 9(2), 46-55. doi: 10.11648/j.ijde.20240902.13

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    AMA Style

    Azibte G, Ayalew Z, Tsige K, Molla B, Weldeamanuel M, et al. Risk Factors for Ten-Year Risk of Osteoporosis in Type 2 DM Patients Attending Tikur Anbessa Specialized Hospital Diabetic Center Cross-sectional Study. Int J Diabetes Endocrinol. 2024;9(2):46-55. doi: 10.11648/j.ijde.20240902.13

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  • @article{10.11648/j.ijde.20240902.13,
      author = {Gebeyehu Azibte and Zekarias Ayalew and Kibrekidusan Tsige and Bereket Molla and Mahlet Weldeamanuel and Waltengus Birhanu and Biruk Legesse},
      title = {Risk Factors for Ten-Year Risk of Osteoporosis in Type 2 DM Patients Attending Tikur Anbessa Specialized Hospital Diabetic Center Cross-sectional Study
    },
      journal = {International Journal of Diabetes and Endocrinology},
      volume = {9},
      number = {2},
      pages = {46-55},
      doi = {10.11648/j.ijde.20240902.13},
      url = {https://doi.org/10.11648/j.ijde.20240902.13},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijde.20240902.13},
      abstract = {Background: Type 2 diabetes mellitus (T2DM) is a major contributing factor to osteoporotic fractures via different mechanisms. This study assessed the ten-year risk of osteoporosis and associated factors for osteoporotic fractures in T2DM patients. Methods: Data from 175 type diabetes mellites (T2DM) patients over 40 years attending a diabetes clinic at Tikur Anbessa Specialized Hospital (TASH) were collected. Demographic information, diabetic complications, blood sugar levels, and other medical illnesses were collected by a structured questionnaire and from an electronic medical record system. The 10-year fracture risk assessment (FRAX) tool was used without bone mineral density (BMD) measurement. multivariate logistic regression was used to analyze factors associated with fragility fractures. Results: Half the participants were female, with a median age of 60. Most were married, well-educated, and urban residents. The median duration of diabetes was 11 years. The median FRAX score indicated a moderate 10-year risk of hip fracture (≥3%) and a high risk of major osteoporotic fracture (≥20%). Overall, 30.9% of patients had a high 10-year risk of osteoporotic fracture. The majority (78.3%) had macrovascular complications, with neuropathy, retinopathy, and nephropathy being the common ones. Higher FBS, higher HbA1c, and the presence of macrovascular complications were significantly associated with a higher risk of fractures. Conclusion: This study found a high prevalence (30.9%) of a 10-year risk of osteoporotic fractures in T2 DM patients. Poor glycemic control (higher HbA1c and FBS) and the presence of macrovascular complications were significantly associated with an increased 10-year osteoporotic fracture risk.
    },
     year = {2024}
    }
    

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  • TY  - JOUR
    T1  - Risk Factors for Ten-Year Risk of Osteoporosis in Type 2 DM Patients Attending Tikur Anbessa Specialized Hospital Diabetic Center Cross-sectional Study
    
    AU  - Gebeyehu Azibte
    AU  - Zekarias Ayalew
    AU  - Kibrekidusan Tsige
    AU  - Bereket Molla
    AU  - Mahlet Weldeamanuel
    AU  - Waltengus Birhanu
    AU  - Biruk Legesse
    Y1  - 2024/06/06
    PY  - 2024
    N1  - https://doi.org/10.11648/j.ijde.20240902.13
    DO  - 10.11648/j.ijde.20240902.13
    T2  - International Journal of Diabetes and Endocrinology
    JF  - International Journal of Diabetes and Endocrinology
    JO  - International Journal of Diabetes and Endocrinology
    SP  - 46
    EP  - 55
    PB  - Science Publishing Group
    SN  - 2640-1371
    UR  - https://doi.org/10.11648/j.ijde.20240902.13
    AB  - Background: Type 2 diabetes mellitus (T2DM) is a major contributing factor to osteoporotic fractures via different mechanisms. This study assessed the ten-year risk of osteoporosis and associated factors for osteoporotic fractures in T2DM patients. Methods: Data from 175 type diabetes mellites (T2DM) patients over 40 years attending a diabetes clinic at Tikur Anbessa Specialized Hospital (TASH) were collected. Demographic information, diabetic complications, blood sugar levels, and other medical illnesses were collected by a structured questionnaire and from an electronic medical record system. The 10-year fracture risk assessment (FRAX) tool was used without bone mineral density (BMD) measurement. multivariate logistic regression was used to analyze factors associated with fragility fractures. Results: Half the participants were female, with a median age of 60. Most were married, well-educated, and urban residents. The median duration of diabetes was 11 years. The median FRAX score indicated a moderate 10-year risk of hip fracture (≥3%) and a high risk of major osteoporotic fracture (≥20%). Overall, 30.9% of patients had a high 10-year risk of osteoporotic fracture. The majority (78.3%) had macrovascular complications, with neuropathy, retinopathy, and nephropathy being the common ones. Higher FBS, higher HbA1c, and the presence of macrovascular complications were significantly associated with a higher risk of fractures. Conclusion: This study found a high prevalence (30.9%) of a 10-year risk of osteoporotic fractures in T2 DM patients. Poor glycemic control (higher HbA1c and FBS) and the presence of macrovascular complications were significantly associated with an increased 10-year osteoporotic fracture risk.
    
    VL  - 9
    IS  - 2
    ER  - 

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