BONE MINERAL DENSITY AND PROBABILITY OF OSTEOPOROTIC FRACTURES IN WOMEN WITH TYPE II DIABETES MELLITUS.

OBJECTIVE: The aim: To assess bone mineral density and 10-year probability of major osteoporotic and hip fractures using the Ukrainian FRAX® version for postmenopausal women with Type II diabetes mellitus and to determine the need for OP treatment according to the algorithm FRAX and BMD. PATIENTS AND METHODS: Materials and methods: 690 females aged 50-89 years (mean age 67.0±7.7 years) were divided into two groups: Group I (n=345) was made of mostly healthy women, Group II (n=345) - patients with Type II diabetes mellitus. Bone mineral density was measured using dual-energy X-ray absorptiometry, 10-year probability of major osteoporotic and hip fractures was calculated using the Ukrainian FRAX® model. RESULTS: Results: Bone mineral density and 10-year risk of major osteoporotic and hip fractures did not differ depending on the Type II diabetes mellitus presence, however the frequencies of low-energy, vertebral and all previous fractures were higher in Group II. 19% of women with diabetes mellitus and 38% of healthy ones required antiosteoporotic treatment according to dual-energy X-ray absorptiometry and only 8% and 2%, respectively, according to the FRAX. These indices became higher after recalculation of FRAX taking into account bone mineral density, however they were lower in patients with diabetes mellitus compared to the corresponding rate in the Group I (FRAX (high risk) + bone mineral density: 26% and 41%; χ2 = 18.2; p<0.001). CONCLUSION: Conclusions: The use of FRAX in combination with bone mineral density resulted in an increased necessity for antiosteoporotic treatment, indicating the urgency of using both indices for osteoporotic fractures prediction in patients with Type II diabetes mellitus.

FRAX-Based Intervention Thresholds for Osteoporosis Treatment in Ukraine.

OBJECTIVES: Osteoporosis, in addition to its consequent fracture burden, is a common and costly condition. FRAX® is a well-established, validated, web-based tool which calculates the 10-year probability of fragility fractures. A FRAX model for Ukraine has been available since 2016 but its output has not yet been translated into intervention thresholds for the treatment of osteoporosis in Ukraine; we aimed to address this unmet need in this analysis. METHODS: In a referral population sample of 3790 Ukrainian women, 10-year probabilities of major osteoporotic fracture (MOF) and hip fracture separately were calculated using the Ukrainian FRAX model, with and without femoral neck bone mineral density (BMD). We used a similar approach to that first proposed by the UK National Osteoporosis Guideline Group, whereby treatment is indicated if the probability equals or exceeds that of a woman of the same age with a prior fracture. RESULTS: The MOF intervention threshold in females (the age-specific 10-year fracture probability) increased with age from 5.5% at the age of 40 years to 11% at the age of 75 years where it plateaued and then decreased slightly at age 90 (10%). Lower and upper thresholds were also defined to determine the need for BMD, if not already measured; the approach targets BMD measurements to those at or near the intervention threshold. The proportion of the referral populations eligible for treatment, based on prior fracture or similar or greater probability, ranged from 44% to 69% depending on age. The prevalence of the previous fracture rose with age, as did the proportion eligible for treatment. In contrast, the requirement for BMD testing decreased with age. CONCLUSIONS: The present study describes the development and application of FRAX-based assessment guidelines in Ukraine. The thresholds can be used in the presence or absence of access to BMD and optimize the use of BMD where access is restricted.

Bone mineral density and trabecular bone score in postmenopausal women with knee osteoarthritis and obesity.

OBJECTIVE: The aim of the study was to investigate the relationship between bone mineral density (BMD) of lumbar spine, femoral neck, trabecular bone score (TBS) and body mass index (BMI), in postmenopausal women with knee osteoarthritis (OA). PATIENTS AND METHODS: Materials and methods: The study group comprised 359 postmenopausal women aged 50-89 years. They were divided into 2 groups: I group - 117 postmenopausal women with symptomatic knee OA and II group -242 women with a normal functional activity of knee joints. Analysis of data was performed taking into account their BMD of lumbar spine (L1-L4) and femoral neck, measured by the Dual-energy X-ray absorptiometry (DXA) Hologic (Discovery WI, USA, 2016). TBS of L1-L4 was detected by TBS insight® software (MedImaps, Pessac, France), and BMI classified by World Health Organization (WHO). RESULTS: Results: In postmenopausal women with obesity prevalence of symptomatic knee OA was detected in 41.1% of cases. However, in women with normal BMI knee OA was revealed in 29.0% of women. The highest level of knee OA in obese women aged 70-79 years - 45.8%. According to a chi-squared (χ2) test, a significantly higher level of BMI was detected in postmenopausal women with OA (χ2=5.05, p=0.02). CONCLUSION: Conclusion: Women with a symptomatic OA had a significantly higher BMD of lumbar spine compared with women who had a normal functional activity of knee. Significant negative correlation were detected between TBS and BMI, and significant positive correlations between lumbar spine BMD and BMI.