Assessment of fracture risk in patients with diabetes

Оlexander Kchvisiuk, Anatoly Sykal, Vladimir Babalyan, A. Kalchenko


Type II diabetes along with metabolic, cardiovascular and neu­rological complications, dysfunction of organs and systems leads to decreasing of bone mineral density and consequently to an increasing risk of fractures. Objective: To assess the absolute risk of fracture in patients with diabetes mellitus type II, using models of algorithms FRAX and QFracture, as well as to perform a com­parative analysis of these models. Methods: The study included 96 women with type II diabetes (average age (63,1 ± 0,8), body mass index (32,3 ± 0,49) kg/m2). According to anamnesis data of patients we evaluated absolute 10-year fracture risk using algo­rithmic systems FRAX and QFracture. Statistical data processing was carried out using MS Exel software and IBM SPSS Statistics 20. The sensitivity and specificity of methods were calculated with using of ROC-curves. Results: correlative link between the FRAX and QFracture for evaluation the 10-year risk of fracture was detected. It is established that the risk of vertebral fracture, distal forearm and humerus in patients with type II diabetes is much higher than the risk of fracture in the area of the femoral neck. Indicators of risk of fracture in studied women received with using of FRAX and QFracture exceeded those ones in popu­lations. Based on the ROC-analysis conducted for age groups 50–59, 60–69, and 70–79 years it was found high specificity and sensitivity of the methods. Conclusion: algorithmic system FRAX and QFracture have high diagnostic value, make it possible to calculate the absolute risk of fractures and to decide necessity of antiresorptive therapy. However monitoring of treatment can be made only by means of bone densitometers. Advantage of QFracture is an opportunity of fracture risk assessment in the range from 1 to 10 years.


type II diabetes; women; algorithm FRAX; QFracture; probability of fracture


Osteoporosis in the European Union: medical management, epidemiology and economic burden. A report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA) / E. Hernlund, A. Svedbom, M. Ivergard [et al.] // Arch. Osteoporos. — 2013. — Vol. 8 (1–2). — 136 p, doi: 10.1007/s11657-013-0136.

Ip T. P. Management of osteoporosis in patients hospitalized for hip fractures / T. P. Ip, J. Leung, A. W. C. Kung // Osteoporos Int. — 2010. — Vol. 21 (Suppl. 4). — P. S605–S614, doi: 10.1007/s00198-010-1398-8.

A seventy percent overestimation of the burden of hip fractures in women aged 85 and over / C. M. Couris, A. Duclos, M. Rabilloud [et al.] // Bone. — 2007. — Vol. 41 (5). — P. 896–900.

Cummings S Epidemiology and outcomes of osteoporotic fractures / S. Cummings, L. Melton // Lancet. — 2002. — Vol. 359. — P. 1761–1767.

Risk adjusted mortality rates of elderly veterans with hip frac¬tures / E. Bass, D. D. French, D. D. Bradham, L. Z. Rubenstein // Ann. Epidemiol. — 2007. — Vol. 17 (7). — P. 514–519.

Mortality risk associated with low-trauma osteoporotic frac¬ture and subsequent fracture in men and women / D. Bliuc, N. D. Nguyen, V. E. Milch [et al.] // JAMA. — 2009. — Vol. 301 (17). — P. 513–521, doi: 10.1001/jama.2009.50.

Compston J. Osteoporosis: social and economic impact / J. Compston // Radiol. Clin. N. Am. — 2010. — Vol. 48 (3). — P. 477–482, doi: 10.1016/j.rcl.2010.02.010.

The cost of osteoporotic fractures in the United Kingdom / R. T. Burge, D. Worley, A. Johansen, U. Bose // J. Med. Econ. — 2001. — Vol. 4. — P. 51–62.

Evaluation of bone mineral density in premenopausal women with type — 2 diabetes mellitus in Zahedan, southeast Iran / Z. Zakeri, Z. Azizi, H. Mehrabifar, M. Hashemi // J. Pak. Med. Assoc. — 2011. — Vol. 61 (5). — P. 443–445.

Changes of bone mineral density in diabetes / A. A. Gusov, MG Pavlov, G. A. Melnichenko [et al.] // Clinician. — 2010. — № 1. — P. 9–15.

Shu A. Bone structure and turnover in type 2 diabetes mellitus / A. Shu, M. T. Yin, E. Stein [et al.] // Osteoporos. Int. — 2012. — Vol. 23 (2). — P. 635–641, doi: 10.1007/s00198-011-1595-0.

Ruyatkina L. A. Вone health in diabetes mellitus type 2 / L. A. Ruyatkina, A. V. Lomov, D. S. Ruyatkin // Farmateka. — 2013. — № 5.– P. 25–31.

Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes — a meta-analysis / P. Vestergaard // Osteoporos Int. — 2007. — Vol. 18 (4). — P. 427–444.

Garnero P. Evaluation of a fully automated serum assay for total N-terminal propeptide of type I collagen in postmenopausal osteoporosis / P. Garnero, P. Vergnaud, N. Hoyle // Clin. Chem. — 2008. — Vol. 54 (1). — P. 188–196.

Diabetic patients have anincreased risk of vertebral fractures independentof BMD or diabetic complications / M. Yamamoto, T. Yamaguchi, M. Yamauchi [et al] // J. Bone Miner. Res. — 2009. — Vol. 24, (4). — P. 702–709, doi: 10.1359/jbmr.081207.

Bone mineral density is notsensitive enough to assess the risk of vertebral fractures in type 2 diabetic women / M. Yamamoto, T. Yamaguchi, M. Yamauchi [et al.] // Calcif. TissueInt. — 2007. — Vol. 80 (6). — P. 353–358.

Kanis J. A. FRAX and the assessment of the fracture probability in men and women from UK / J. A. Kanis // Osteoporos. Int. — 2008. — Vol. 19 (4). — P. 385–397, doi: 10.1007/s00198-007-0543-5.

Kanis J. A. on behalf of the World Health Organization Scientific Group: Assessment of osteoporosis at the primary health-care level. Technical report. — University of Sheffield, UK: WHO Collaborating Center, 2008. — 339 p.

Povoroznyuk V. V. FRAX as prediction of osteoporotic fracture risk / V. V. Povoroznyuk, N. V. Grigorieva // Diseases of the musculoskeletal system in people of all ages (selected lectures, reviews, articles): ): In 4 vols, vol. 4. - Express, 2014. — P. 183–204.

Povoroznyuk V. V. Assessment of the possibilities of using the Austrian model of FRAX in predicting the risk of osteoporotic fractures in Ukrainian women / V. V. Povoroznyuk, N. V. Grigoryeva // Diseases of the musculoskeletal system in people of all ages (selected lectures, reviews, articles): In 4 vols. — Vol. 4 — Express, 2014. — P. 205–216.

FRAX ® WHO Fracture Risk Assessment Tool [web source]. — Access mode:

QFracture®-2013 risk calculator [web source]. — Access mode: www.qfracture org.released

Byuyul A. SPSS: Art processing. Analysis of statistical data and restore hidden patterns / A. Byuyul, P. Tsefel. — 2005. — М.: DiaSoft, 2005. — 608 p.

Osteoporosis in the practice of internist / [V. V. Povoroznyuk, N. V. Grigoryeva, T. V. Orlik et al.] — K .: Ekspres, 2014. — 198 p.

Official Positions for FRAX® clinical regarding falls and frailty: can falls and frailty be used in FRAX®? From Joint Official Positions Development Conference of the International Society for Clinical Densitometry and International Osteoporosis Foundation onFRAX® / T. Masud, N. Binkley, S. Boonen, M.T. Hannan // J. Clin Densitom. — 2011. — Vol. 14 (3). — P. 194–204, doi: 10.1016/j.jocd.2011.05.010.

International Osteoporosis Foundation [Electronic resource]. - Access:

Strategies for avoiding hip impact during sideways falls / S. N. Robinovitch, L. Inkster, J. Maurer, B. Warnick // J. Bone Miner. Res. — 2003. — Vol. 18 (7). — 1267–1273.

New NOF Guidelines and the WHO Fracture Assessment Tool or FRAX [web source]. — March 18, 2008. — Access mode:

Copyright (c) 2015 Оlexander Kchvisiuk, Anatoly Sykal, V. Babalyan, A. Kalchenko

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.