Viral Shah, MD, an endocrinologist and scientist, discusses his research on fracture risk assessment without bone mineral density as a predictor of major fractures in patients with type 1 diabetes (T1D).
Assessing bone fracture risk without bone mineral density (BMD) while inputting type 1 diabetes (T1D) as a secondary osteoporosis was able to predict bone fracture risk very well in people with T1D, said Viral Shah, MD, endocrinologist and associate professor of medicine and pediatrics at the Barbara Davis Center for Diabetes, Adult Clinic School of Medicine at the University of Colorado Anschutz campus.
Can you describe your research examining fracture risk assessment without bone mineral density as a predictor of major fractures in patients with T1D?
As I mentioned, the fracture risk is high in people with type 1 diabetes. Now, the question is "why?" And there are various tools that we can probably diagnose and treat, or manage the osteoporosis or monitor the osteoporosis. For example, the DEXA bone density [scan] where you can diagnose the osteoporosis and then give a treatment and then monitor the patients on treatment to see how much is the change in the bone mineral density. However, those tools are not the greatest tools to predict the fracture risk in people with type 1 diabetes. People with type 1 diabetes have a higher fracture risk, despite if you look at the DEXA BMD and other factors.
Having said that, we did research trying to look at the FRAX scoring system, which is looking at the clinical factors that are also responsible for fracture in addition to the BMD. In people with type 1 diabetes, there is a way to put that type 1 diabetes as a secondary osteoporosis in a FRAX calculation. When you put that, it actually kind of calculates the fracture risk about 3-fold higher, because it takes the fracture risk from rheumatoid arthritis into the secondary osteoporosis anyway; it's kind of a complex model. But in a study that we did, we used the FRAX—but not imputing the BMD into the FRAX model—just looking at all the clinical risk factors, but also putting the secondary osteoporosis OS [overall survival] as years because these patients have type 1 diabetes. And we looked at whether this FRAX score without a BMD would predict the fracture risk or not.
So in this study, we followed people with type 1 diabetes and without diabetes from a study that was actually done for a cardiovascular disease called as CACTI [Coronary Artery Calcification in Type 1 Diabetes] study. We had their baseline clinical variables to impute and calculate the FRAX score, and then we looked at the fracture that happened later in their life. Our study has been published in Bone, which is a very good journal in the field of osteoporosis and bone metabolism. And we showed that the FRAX without BMD, putting in type 1 diabetes as a secondary osteoporosis actually predicts the fracture risk very well in people with type 1 diabetes.
However, this is the first and only study. It's not a prospective study. I would say that this study is more about suggesting that there is a possibility that we can use this tool in a clinical realm to probably predict osteoporosis fractures and treat the patients earlier and not just relying on the DEXA BMD. However, we need more prospective studies to validate our findings.