Comparison of FRAX Score for Osteoporotic Fracture between Type 2 Diabetes and Non-Diabetes Patients with Previous Osteoporotic Hip Fracture

Main Article Content

Pornertai Rattanamaytanon
Prasit Leewattanapat


Objective: To compared Fracture Risk Assessment Tool (FRAX) score in previous hip fracture patients with type 2 diabetes and non-diabetes patients and to ascertain accuracy of FRAX whether using Rheumatoid Arthritis (RA) substitution of diabetes.

Methods: A retrospective study from medical record in patients aged 50 to 100 years with previous osteoporotic hip fracture in Vajira hospital between January 1st, 2014 to January 31st, 2019. Comparing mean of FRAX score between type 2 diabetes and non-diabetes group.

Results: A total of 288 participants with previous osteoporotic hip fracture were included in the study, type 2 diabetes (T2DM) 144 patients (50.88%) and non-diabetic 139 patients (49.12%). The significant lower FRAX score between diabetic and control group was observed for both major osteoporotic (MOF) 6.68±4.66 vs. 8.53±5.26, p = 0.02 and hip fracture (HF) 2.42±2.69 vs. 3.96±3.71, p<0.01 respectively. Adjusted FRAX by substitution RA input for diabetes, the fracture risk estimates in both groups were approximately (MOF 9.09±6.32 vs. 8.53±5.26, p = 0.412 and HF 3.87±4.05 vs. 3.96±3.71, p = 0.888)

Conclusions: The FRAX tool underestimated fracture risk in T2DM compared to non-diabetes patients. The introduction of a correction factor by selecting RA as equivalent variable for T2DM resulted in mean FRAX values no longer significant to those without diabetes subjects which can improve the performance of the FRAX prediction.


Download data is not yet available.

Article Details

Original Articles


NIH consensus development panel on osteoporosis prevention, diagnosis, and therapy. Osteoporosis prevention, diagnosis, and therapy. Jama 2001;285(6):785-95.

Taechakraichana N, Angkawanich P, Panyakhamlerd K, Limpaphayom K. Postmenopausal osteoporosis: what is the real magnitude of the problem in the Thai population?. J Med Assoc Thai 1998;81(6):397-401.

Hernlund E, Svedbom A, Ivergard M, Compston J, Cooper C, Stenmark J, et al. 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). Arch Osteoporos 2013;8:136.

Papaioannou A, Morin S, Cheung AM, Atkinson S, Brown JP, Feldman S, et al. 2010 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010;182(17):1864-73.

Melton LJ, Thamer M, Ray NF, Chan JK, Chesnut CH, Einhorn TA, et al. Fractures attributable to osteoporosis: report from the National Osteoporosis Foundation. J Bone Miner Res 1997;12(1):16-23.

Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 2007;166(5):495-505.

Ma L, Oei L, Jiang L, Estrada K, Chen H, Wang Z, et al. Association between bone mineral density and type 2 diabetes mellitus: a meta-analysis of observational studies. European journal of epidemiology 2012; 27(5):319-32.

De L II, Van der Klift M, De Laet CE, Van Daele PL, Hofman A, Pols HA. Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos Int 2005;16(12): 1713-20.

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(4):427-44.

Strotmeyer ES, Cauley JA, Schwartz AV, Nevitt MC, Resnick HE, Zmuda JM, et al. Diabetes is associated independently of body composition with BMD and bone volume in older white and black men and women: The Health, Aging, and Body Composition Study. J Bone Miner Res 2004;19(7):1084-91.

Bonds DE, Larson JC, Schwartz AV, Strotmeyer ES, Robbins J, Rodriguez BL, et al. Risk of fracture in women with type 2 diabetes: the women's health initiative observational study. J Clin Endocrinol Metab 2006;91(9):3404-10.

Jackuliak P, Payer J. Osteoporosis, fractures, and diabetes. Int J Endocrinol 2014; 2014:820615.

Sanches CP, Vianna AGD, Barreto FC. The impact of type 2 diabetes on bone metabolism. Diabetol Metab Syndr 2017;9:85.

Ying Li JY, Miao Xuan. Assessment of fracture risk by FRAX model in older adults with type 2 diabetes: a cross-sectional study in China. International Journal of Clinical and Experimental Medicine 2006;9(10):20432-8.

Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int 2008;19(4):385-97.

Kanis JA, McCloskey EV, Johansson H, Strom O, Borgstrom F, Oden A, et al. Case finding for the management of osteoporosis with FRAX--assessment and intervention thresholds for the UK. Osteoporos Int 2008;19(10):1395-408.

Schwartz AV VE, Bauer DC, Hillier TA, Strotmeyer ES, Ensrud KE, Donaldson MG, et al. Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. The Journal of the American Medical Association 2001;2184:305-92.

Leslie WD, Johansson H, McCloskey EV, Harvey NC, Kanis JA, Hans D. Comparison of methods for improving fracture risk assessment in diabetes: The Manitoba BMD registry. J Bone Miner Res 2018; 33(11): 1923-30.

Leslie WD, Hough S. Fracture risk assessment in diabetes. In: Lecka-Czernik B, Fowlkes JL, editors. Diabetic Bone Disease .Springer; 2016. p 69-45.

Valentini A, Cianfarani MA, De Meo L, Morabito P, Romanello D, Tarantino U, et al. FRAX tool in type 2 diabetic subjects: the use of HbA1c in estimating fracture risk. Acta Diabetol 2018;55(10): 1043-50.

Van Daele PL, Stolk RP, Burger H, Algra D, Grobbee DE, Hofman A, et al. Bone density in non-insulin-dependent diabetes mellitus. The Rotterdam Study. Ann Intern Med 1995; 122(6):409-14.

Carnevale V, Morano S, Fontana A, Annese MA, Fallarino M, Filardi T, et al. Assessment of fracture risk by the FRAX algorithm in men and women with and without type 2 diabetes mellitus: a cross-sectional study. Diabetes Metab Res Rev 2014; 30(4): 313-22.

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.