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Diagnosing Osteoporosis in Diabetes—A Systematic Review on BMD and Fractures

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Abstract

Purpose of Review

Recently, the American Diabetes Association updated the 2024 guidelines for Standards of Care in Diabetes and recommend that a T-score of − 2.0 in patients with diabetes should be interpreted as equivalent to − 2.5 in people without diabetes. We aimed to evaluate the most recent findings concerning the bone mineral density (BMD)-derived T-score and risk of fractures related to osteoporosis in subjects with diabetes.

Recent Findings

The dual-energy X-ray absorptiometry (DXA) scan is the golden standard for evaluating BMD. The BMD-derived T-score is central to fracture prediction and signifies both diagnosis and treatment for osteoporosis. However, the increased fracture risk in diabetes is not sufficiently explained by the T-score, complicating the identification and management of fracture risk in these patients.

Summary

Recent findings agree that subjects with type 2 diabetes (T2D) have a higher T-score and higher fracture risk compared with subjects without diabetes. However, the actual number of studies evaluating the direct association of higher fracture risk at higher T-score levels is scant. Some studies support the adjustment based on the 0.5 BMD T-score difference between subjects with T2D and subjects without diabetes. However, further data from longitudinal studies is warranted to validate if the T-score treatment threshold necessitates modification to prevent fractures in subjects with diabetes.

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Data Availability

The evidence in this systematic literature study is based on already published data and is summarized in Table 1.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Vestergaard P. Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes - a meta-analysis. Osteoporos Int. 2007;18:427–44. https://doi.org/10.1007/s00198-006-0253-4.

    Article  CAS  PubMed  Google Scholar 

  2. Hough FS, Pierroz DD, Cooper C, Ferrari SL. Mechanisms and evaluation of bone fragility in type 1 diabetes mellitus. Eur J Endocrinol. 2016;174:R127–38. https://doi.org/10.1530/EJE-15-0820.

    Article  CAS  PubMed  Google Scholar 

  3. Shah VN, Harrall KK, Shah CS, et al. Bone mineral density at femoral neck and lumbar spine in adults with type 1 diabetes: a meta-analysis and review of the literature. Osteoporos Int. 2017;28:2601–10. https://doi.org/10.1007/s00198-017-4097-x.

    Article  CAS  PubMed  Google Scholar 

  4. Schwartz AV, Vittinghoff E, Bauer DC, et al. Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. Jama. 2011;305:2184–92. https://doi.org/10.1001/jama.2011.715.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. Eastell R, Vittinghoff E, Lui L-Y, et al (2022) Diabetes mellitus and the benefit of antiresorptive therapy on fracture risk. Bone Rep 16. https://doi.org/10.1016/j.bonr.2022.101190

  6. Anagnostis P, Paschou SA, Gkekas NN, et al. Efficacy of anti-osteoporotic medications in patients with type 1 and 2 diabetes mellitus: a systematic review. Endocrine. 2018;60:373–83. https://doi.org/10.1007/s12020-018-1548-x.

    Article  CAS  PubMed  Google Scholar 

  7. Bliuc D, Tran T, Chen W, et al. The association between multimorbidity and osteoporosis investigation and treatment in high-risk fracture patients in Australia: a prospective cohort study. PLoS Med. 2023;20:e1004142. https://doi.org/10.1371/journal.pmed.1004142.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Fraser LA, Papaioannou A, Adachi JD, et al. Fractures are increased and bisphosphonate use decreased in individuals with insulin-dependent diabetes: a 10 year cohort study. BMC Musculoskelet Disord. 2014;15:1–9. https://doi.org/10.1186/1471-2474-15-201.

    Article  CAS  Google Scholar 

  9. Vilaca T, Schini M, Harnan S, 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. https://doi.org/10.1016/j.bone.2020.115457.

    Article  PubMed  Google Scholar 

  10. Sheffield TU of FRAX(R). https://frax.shef.ac.uk/FRAX/tool.aspx?country=29.

  11. Society DE Danish national treatment guideline. https://endocrinology.dk/nbv/calcium-og-knoglemetabolisme/postmenopausal-osteoporose/.

  12. Champakanath A, Keshawarz A, Pyle L, et al. Fracture risk assessment (FRAX) without BMD and risk of major osteoporotic fractures in adults with type 1 diabetes. Bone. 2021;143:115614. https://doi.org/10.1016/j.bone.2020.115614.

    Article  PubMed  Google Scholar 

  13. Morin SN, Feldman S, Funnell L, et al. Clinical practice guideline for management of osteoporosis and fracture prevention in Canada : 2023 update. CMAJ. 2023;195:1333–48. https://doi.org/10.1503/cmaj.221647.

    Article  Google Scholar 

  14. Ferrari SL, Abrahamsen B, Napoli N, et al. Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int. 2018;29:2585–96. https://doi.org/10.1007/s00198-018-4650-2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  15. Elsayed NA, Aleppo G, Aroda VR, et al. 4. Comprehensive medical evaluation and assessment of comorbidities: standards of care in diabetes—2023. Diabetes Care. 2023;46:S49–67. https://doi.org/10.2337/dc23-S004.

    Article  CAS  PubMed  Google Scholar 

  16. Wells G, Shea B, O’connell D, Peterson J, Welch V, Losos M (2000) Newcastle-Ottawa Scale.

  17. Herzog R, Álvarez-Pasquin MJ, Díaz C, et al (2013) Are healthcare workers intentions to vaccinate related to their knowledge, beliefs and attitudes? A systematic review. BMC Public Health 13:. https://doi.org/10.1186/1471-2458-13-154.

  18. Shea BJ, Reeves BC, Wells G, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:1–9. https://doi.org/10.1136/bmj.j4008.

    Article  Google Scholar 

  19. Levels of evidence - centre for evidence-based medicine (University of Oxford). 2009; https://www.cebm.ox.ac.uk/resources/levels-of-evidence/oxford-centre-for-evidence-based-medicine-levels-of-evidence-march-2009. Accessed 12 Oct 2023.

  20. •• Agarwal A, Leslie WD, Nguyen TV, et al. Performance of the Garvan fracture risk calculator in individuals with diabetes: a registry-based cohort study. Calcif Tissue Int. 2022;110:658–65. https://doi.org/10.1007/s00223-021-00941-1. This study is interesting as it includes from the MANITOBA data only from 2012 to 2018 and does not report of higher BMD in type 2 diabetes subjects with fractures compared to subjects without diabetes.

    Article  CAS  PubMed  Google Scholar 

  21. Valentini A, Cianfarani MA, Federici M, et al. Osteoprotegerin in diabetic osteopathy. Nutr Metab Cardiovasc Dis. 2020;30:49–55. https://doi.org/10.1016/j.numecd.2019.08.018.

    Article  CAS  PubMed  Google Scholar 

  22. Lasschuit JWJ, Center JR, Greenfield JR, Tonks KTT. Comparison of calcaneal quantitative ultrasound and bone densitometry parameters as fracture risk predictors in type 2 diabetes mellitus. Diabet Med. 2020;37:1902–9. https://doi.org/10.1111/dme.14183.

    Article  CAS  PubMed  Google Scholar 

  23. van Hulten V, Sarodnik C, Driessen JHM, et al. Prevalent morphometrically assessed vertebral fractures in individuals with type 2 diabetes, prediabetes and normal glucose metabolism: the Maastricht study. Front Endocrinol (Lausanne). 2022;13:832977. https://doi.org/10.3389/fendo.2022.832977.

    Article  PubMed  Google Scholar 

  24. Zhukouskaya VV, Eller-Vainicher C, Vadzianava VV, et al. Prevalence of morphometric vertebral fractures in patients with type 1 diabetes. Diabetes Care. 2013;36:1635–40. https://doi.org/10.2337/dc12-1355.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  25. Anna U-M, Maria S, Kerstin B. Comparison of quantitative ultrasound of calcaneus and dual energy X-ray absorptiometry in measuring bone density and predicting fractures in patients with diabetic polyneuropathy: a prospective cohort study. Diabetes Res Clin Pract. 2021;180:109064. https://doi.org/10.1016/j.diabres.2021.109064.

    Article  PubMed  Google Scholar 

  26. 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. 2023. https://doi.org/10.1007/s40618-023-02122-3.

    Article  PubMed  Google Scholar 

  27. Cairoli E, Grassi G, Gaudio A, et al. Validation of the clinical consensus recommendations on the management of fracture risk in postmenopausal women with type 2 diabetes. Nutr Metab Cardiovasc Dis. 2023;33:158–67. https://doi.org/10.1016/j.numecd.2022.10.004.

    Article  PubMed  Google Scholar 

  28. Meng C, Zhao D, Ye X-H. Association of body composition with bone mineral density and fractures in Chinese male type 2 diabetes mellitus. Medicine (Baltimore). 2023;102:e33400. https://doi.org/10.1097/MD.0000000000033400.

    Article  CAS  PubMed  Google Scholar 

  29. Lin Y-C, Wu J, Kuo S-F, et al. Vertebral fractures in type 2 diabetes patients: utility of trabecular bone score and relationship with serum bone turnover biomarkers. J Clin Densitom. 2020;23:37–43. https://doi.org/10.1016/j.jocd.2019.01.003.

    Article  PubMed  Google Scholar 

  30. Schwartz AV, Backlund J-YC, de Boer IH, et al. Risk factors for lower bone mineral density in older adults with type 1 diabetes: a cross-sectional study. Lancet Diabetes Endocrinol. 2022;10:509–18. https://doi.org/10.1016/S2213-8587(22)00103-6.

    Article  CAS  PubMed  Google Scholar 

  31. Dhaliwal R, Ewing SK, Vashishth D, et al. Greater carboxy-methyl-lysine is associated with increased fracture risk in type 2 diabetes. J Bone Miner Res. 2022;37:265–72. https://doi.org/10.1002/jbmr.4466.

    Article  CAS  PubMed  Google Scholar 

  32. Alfadhli EM, Alsharif AS, Alharbi RA, et al. Comparison of bone mineral density and Fracture Risk Assessment Tool in Saudi women with and without type 2 diabetes mellitus. Saudi Med J. 2022;43:700–7. https://doi.org/10.15537/SMJ.2022.43.7.20220144.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Pechmann LM, Petterle RR, Moreira CA, Borba VZC. Osteosarcopenia and trabecular bone score in patients with type 2 diabetes mellitus. Arch Endocrinol Metab. 2021;65:801–10. https://doi.org/10.20945/2359-3997000000418.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Koç Z. The effect of type 2 diabetes mellitus on osteopenia and vertebral fractures in elderly women. Turk Osteoporoz Derg. 2022;28:125–30. https://doi.org/10.4274/tod.galenos.2021.35403.

    Article  Google Scholar 

  35. Abdelmaksoud NM, Abulsoud AI, Abulsoud MI, Elshaer SS. Genetic impact of vitamin D receptor TaqI polymorphism on the risk of osteoporotic fractures in diabetic patients. Gene Rep. 2022;27:101591. https://doi.org/10.1016/j.genrep.2022.101591.

    Article  CAS  Google Scholar 

  36. Gani LU, Saripalli KR, Fernandes K, et al. Bone mineral density and trabecular bone score in elderly type 2 diabetes Southeast Asian patients with severe osteoporotic hip fractures. PLoS One. 2020;15:e0241616. https://doi.org/10.1371/journal.pone.0241616.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Sihota P, Yadav RN, Dhaliwal R, et al. Investigation of mechanical, material, and compositional determinants of human trabecular bone quality in type 2 diabetes. J Clin Endocrinol Metab. 2021;106:E2271–89. https://doi.org/10.1210/clinem/dgab027.

    Article  PubMed  Google Scholar 

  38. Sihota P, Pal R, Naresh Yadav R, et al. Can fingernail quality predict bone damage in type 2 diabetes mellitus? a pilot study. PLoS One. 2021;16:e0257955. https://doi.org/10.1371/journal.pone.0257955.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  39. Sheu A, Bliuc D, Tran T, et al. Fractures in type 2 diabetes confer excess mortality: The Dubbo osteoporosis epidemiology study. Bone. 2022;159:116373. https://doi.org/10.1016/j.bone.2022.116373.

    Article  PubMed  Google Scholar 

  40. • Schousboe JT, Morin SN, Kline GA, et al. Differential risk of fracture attributable to type 2 diabetes mellitus according to skeletal site. Bone. 2022;154:116220. https://doi.org/10.1016/j.bone.2021.116220. This study analyses data from the Manitoba cohort and finds elevated fracture risk among subjects with type 2 diabetes, namely hip and humerus fractures.

    Article  CAS  PubMed  Google Scholar 

  41. •• Koromani F, Oei L, Shevroja E, et al. Vertebral fractures in individuals with type 2 diabetes: more than skeletal complications alone. Diabetes Care. 2020;43:137–44. https://doi.org/10.2337/dc19-0925. This systematic review and metanalysis includes a high number of total participants from major cohort studies and find that the risk of fractures is increased in individuals with type 2 diabetes, especially in those with osteopenia.

    Article  PubMed  Google Scholar 

  42. Cummings SR, Black DM, Michael C, Nevitt P, et al. Appendicular bone density and age predict hip fracture in women. JAMA - J Am Med Assoc. 1990;263:665–8. https://doi.org/10.1001/jama.1990.03440050059033.

    Article  CAS  Google Scholar 

  43. Tenenhouse A, Joseph L, Kreiger N, et al. Estimation of the prevalence of low bone density in Canadian women and men using a population-specific DXA reference standard: The Canadian Multicentre Osteoporosis Study (CaMos). Osteoporos Int. 2000;11:897–904. https://doi.org/10.1007/s001980070050.

    Article  CAS  PubMed  Google Scholar 

  44. McCloskey EV, Beneton M, Charlesworth D, et al. Clodronate reduces the incidence of fractures in community-dwelling elderly women unselected for osteoporosis: results of a double-blind, placebo-controlled randomized study. J Bone Miner Res. 2007;22:135–41. https://doi.org/10.1359/jbmr.061008.

    Article  CAS  PubMed  Google Scholar 

  45. Shevroja E, Marques-Vidal P, Aubry-Rozier B, et al. Cohort profile: the OsteoLaus study. Int J Epidemiol. 2019;48:1046-1047G. https://doi.org/10.1093/ije/dyy276.

    Article  PubMed  Google Scholar 

  46. Ikram MA, Brusselle GGO, Murad SD, et al. The Rotterdam study: 2018 update on objectives, design and main results. Eur J Epidemiol. 2017;32:807–50. https://doi.org/10.1007/s10654-017-0321-4.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Mesinovic J, Scott D, Seibel MJ, et al. Risk factors for incident falls and fractures in older men with and without type 2 diabetes mellitus: the Concord Health and Ageing in Men Project. J Gerontol A Biol Sci Med Sci. 2021;76:1090–100. https://doi.org/10.1093/gerona/glab062.

    Article  CAS  PubMed  Google Scholar 

  48. Paul J, Devarapalli V, Johnson JT, et al. Do proximal hip geometry, trabecular microarchitecture, and prevalent vertebral fractures differ in postmenopausal women with type 2 diabetes mellitus? A cross-sectional study from a teaching hospital in southern India. Osteoporos Int. 2021;32:1585–93. https://doi.org/10.1007/s00198-021-05855-0.

    Article  CAS  PubMed  Google Scholar 

  49. Ramírez Stieben LA, Dobry R, González A, et al. Vertebral fractures in adult women with type 2 diabetes mellitus. Actual osteol. 2020;16:1–9.

    Google Scholar 

  50. de Tejada-Romero MJG, Saavedra-Santana P, de la Rosa-Fernández F, et al. Effect of obesity on fragility fractures, BMD and vitamin D levels in postmenopausal women. Influence of type 2 diabetes mellitus. Acta Diabetol. 2022;59:1201–8. https://doi.org/10.1007/s00592-022-01923-x.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  51. Adami G, Gatti D, Rossini M, et al. Risk of fragility fractures in obesity and diabetes: a retrospective analysis on a nation-wide cohort. Osteoporos Int. 2020;31:2113–22. https://doi.org/10.1007/s00198-020-05519-5.

    Article  CAS  PubMed  Google Scholar 

  52. Giner M, Miranda C, Vázquez-Gámez MA, et al. Microstructural and strength changes in trabecular bone in elderly patients with type 2 diabetes mellitus. Diagnostics. 2021;11:577. https://doi.org/10.3390/diagnostics11030577.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  53. Coll J-C, Garceau É, Leslie WD, et al. Prevalence of vertebral fractures in adults with type 1 diabetes: DenSiFy study (diabetes spine fractures). J Clin Endocrinol Metab. 2022;107:E1860–70. https://doi.org/10.1210/clinem/dgac031.

    Article  PubMed  Google Scholar 

  54. Hanley DA, Brown JP, Tenenhouse A, et al. Associations among disease conditions, bone mineral density, and prevalent vertebral deformities in men and women 50 years of age and older: cross-sectional results from the Canadian Multicentre Osteoporosis Study. J Bone Miner Res. 2003;18:784–90. https://doi.org/10.1359/jbmr.2003.18.4.784.

    Article  CAS  PubMed  Google Scholar 

  55. Vandenput L, Johansson H, McCloskey EV, et al. Update of the fracture risk prediction tool FRAX: a systematic review of potential cohorts and analysis plan. Osteoporos Int. 2022;33:2103–36. https://doi.org/10.1007/s00198-022-06435-6.

    Article  CAS  PubMed  Google Scholar 

  56. Giangregorio LM, Leslie WD, Lix LM, et al. FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res. 2012;27:301–8. https://doi.org/10.1002/jbmr.556.

    Article  PubMed  Google Scholar 

  57. Leslie WD, Morin SN, Majumdar SR, Lix LM. Effects of obesity and diabetes on rate of bone density loss. Osteoporos Int. 2018;29:61–7. https://doi.org/10.1007/s00198-017-4223-9.

    Article  CAS  PubMed  Google Scholar 

  58. Hygum K, Harsløf T, Jørgensen NR, et al. Bone resorption is unchanged by liraglutide in type 2 diabetes patients: a randomised controlled trial. Bone. 2020;132:115197. https://doi.org/10.1016/j.bone.2019.115197.

    Article  CAS  PubMed  Google Scholar 

  59. Iepsen EW, Lundgren JR, Hartmann B, et al. GLP-1 receptor agonist treatment increases bone formation and prevents bone loss in weight-reduced obese women. J Clin Endocrinol Metab. 2015;100:2909–17. https://doi.org/10.1210/jc.2015-1176.

    Article  CAS  PubMed  Google Scholar 

  60. Kvist AV, Nasser MI, Vestergaard P, et al. Site-specific fracture incidence rates among patients with type 1 diabetes, type 2 diabetes, or without diabetes in Denmark (1997–2017). Diabetes Care. 2023;46:633–42. https://doi.org/10.2337/dc22-1004.

    Article  PubMed  PubMed Central  Google Scholar 

  61. McDonough AK, Rosenthal RS, Cao X, Saag KG. The effect of thiazolidinediones on BMD and osteoporosis. Nat Clin Pract Endocrinol Metab. 2008;4:507–13. https://doi.org/10.1038/ncpendmet0920.

    Article  CAS  PubMed  Google Scholar 

  62. Sundhedsdatastyrelsen (2023) MEDSTAT.DK. https://medstat.dk/da. Accessed 9 Oct 2023.

  63. Schwartz AV, Ewing SK, Porzig AM, et al. Diabetes and change in bone mineral density at the hip, calcaneus, spine, and radius in older women. Front Endocrinol (Lausanne). 2013;4:1–9. https://doi.org/10.3389/fendo.2013.00062.

    Article  CAS  Google Scholar 

  64. Sanz-Nogués C, Mustafa M, Burke H, et al. Knowledge, perceptions and concerns of diabetes-associated complications among individuals living with type 1 and type 2 diabetes mellitus. Healthc. 2020;8:1–12. https://doi.org/10.3390/healthcare8010025.

    Article  Google Scholar 

  65. Drummond K, Bennett R, Gibbs J, et al. Perceptions of fracture and fall risk and of the benefits and barriers to exercise in adults with diabetes. Osteoporos Int. 2022;33:2563–73. https://doi.org/10.1007/s00198-022-06524-6.

    Article  PubMed  PubMed Central  Google Scholar 

  66. Viggers R, Starup-Linde J, Vestergaard P. Discrepancies in type of first major osteoporotic fracture and anti-osteoporotic therapy in elderly people with type 2 diabetes mellitus: A retrospective Danish cohort study. Bone. 2023;171:116745. https://doi.org/10.1016/j.bone.2023.116745.

    Article  CAS  PubMed  Google Scholar 

  67. Leslie WD, Johansson H, McCloskey EV, et al. Comparison of methods for improving fracture risk assessment in diabetes: the Manitoba BMD Registry. J Bone Miner Res. 2018;33:1923–30. https://doi.org/10.1002/jbmr.3538.

    Article  PubMed  Google Scholar 

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Funding

During the conduct of the study, Dr. Viggers and Dr. Brandt received grants from Novo Nordisk Foundation, Denmark (grants no. NNF18OC0052064 and no. NNF20OC0065960, respectively).

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Authors and Affiliations

  1. Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark

    Inge Agnete Gerlach Brandt, Sally Søgaard Andersen & Rikke Viggers

  2. Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark

    Jakob Starup-Linde

  3. Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

    Inge Agnete Gerlach Brandt, Sally Søgaard Andersen & Rikke Viggers

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  1. Inge Agnete Gerlach Brandt
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Contributions

I.B. and R.V. performed the initial search and (independently) evaluated results for eligibility J.S-L. was consulted in cases of doubt. The manuscript was written in collaboration between I.B., R.V and J.S-L. and critically revised by S.A. Supplemental material was set up by I.B. and calculations were performed by I.B.

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Correspondence to Inge Agnete Gerlach Brandt.

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Conflict of Interest

Dr. Viggers holds shares in Novo Nordisk. During the conduct of the study, Dr. Starup-Linde presented for UCB Nordic A/S. Apart from this, the authors have no conflict of interest to declare.

Human and Animal Rights and Informed Consent

No clinical trials or animal studies were set up in relation to the conduct of this review. The included studies were conducted in accordance with the Helsinki Declaration and national or local ethics committee’s standards.

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Brandt, I.A.G., Starup-Linde, J., Andersen, S.S. et al. Diagnosing Osteoporosis in Diabetes—A Systematic Review on BMD and Fractures. Curr Osteoporos Rep (2024). https://doi.org/10.1007/s11914-024-00867-1

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