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Femoral bone mineral density at the time of hip fracture is higher in women with versus without type 2 diabetes mellitus: a cross-sectional study

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Abstract

Purpose

To compare femoral bone mineral density (BMD) levels in hip-fracture women with versus without type 2 diabetes mellitus (T2DM). We hypothesized that BMD levels could be higher in the women with T2DM than in controls and we aimed to quantify the BMD discrepancy associated with the presence of T2DM.

Methods

At a median of 20 days after the occurrence of an original hip fracture due to fragility we measured BMD by dual-energy x-ray absorptiometry at the non-fractured femur.

Results

We studied 751 women with subacute hip fracture. Femoral BMD was significantly higher in the 111 women with T2DM than in the 640 without diabetes: mean T-score between-group difference was 0.50, (95% CI from 0.30 to 0.69, P < 0.001). The association between the presence of T2DM and femoral BMD persisted after adjustment for age, body mass index, hip-fracture type, neurologic diseases, parathyroid hormone, 25-hydroxyvitamin D and estimated glomerular filtration rate (P < 0.001). For a woman without versus with T2DM, the adjusted odds ratio to have a femoral BMD T-score below the threshold of − 2.5 was 2.13 (95% CI from 1.33 to 3.42, P = 0.002).

Conclusions

Fragility fractures of the hip occurred in women with T2DM at a femoral BMD level higher than in control women. In the clinical assessment of fracture risk, we support the adjustment based on the 0.5 BMD T-score difference between women with and without T2DM, although further data from robust longitudinal studies is needed to validate the BMD-based adjustment of fracture risk estimation.

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Data availability

The data that support the findings of this study are available from the corresponding author, [MDM], upon reasonable request.

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Funding

No funds, grants or other support was received.

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Authors and Affiliations

  1. Division of Physical and Rehabilitation Medicine, Osteoporosis Research Center, Presidio Sanitario San Camillo, Fondazione Opera San Camillo, Strada Santa Margherita 136, 10131, Turin, Italy

    M. Di Monaco, C. Castiglioni, F. Bardesono & E. Milano

  2. Division of Physical and Rehabilitation Medicine, Department of Surgical Sciences, University of Turin, Turin, Italy

    M. Freiburger & G. Massazza

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  1. M. Di Monaco
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  2. C. Castiglioni
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  3. F. Bardesono
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  4. M. Freiburger
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  5. E. Milano
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  6. G. Massazza
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Contributions

MDM: conceived the first idea of the study and planned it. He interpreted data and wrote the first draft of the manuscript and its final version. CC: co-conceived the idea of the study. She was implicated with the management of the patients and collected clinical data. She helped to write the first draft of the manuscript and commented on the following drafts. FB and MF: were implicated with the management of the patients and collected clinical data. They contributed to plan and perform the study. They commented on manuscript drafts. EM: contributed to collect clinical data (he was the chief of the Division where the study was conducted). He commented on the first draft of the manuscript and on the successive versions. GM: co-conceived the idea of the study. He contributed to write the final version. All the authors read and approved the final version of the manuscript.

Corresponding author

Correspondence to M. Di Monaco.

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Conflict of interest

All authors have no financial relationships with any organizations that might have an interest in the present paper and no other relationships or activities that could appear to have influenced the reported study.

Ethical approval

The study was performed in line with the principles of the 1964 Helsinki Declaration and its later amendments. Institutional Review Board approval was obtained for the study protocol (Ethical Committee from City of Health and Science from our city).

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all the women gave their written informed consent to participate in the study.

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Di Monaco, M., Castiglioni, C., Bardesono, F. et al. Femoral bone mineral density at the time of hip fracture is higher in women with versus without type 2 diabetes mellitus: a cross-sectional study. J Endocrinol Invest 47, 59–66 (2024). https://doi.org/10.1007/s40618-023-02122-3

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