Comparison of bone mineral density and Fracture Risk Assessment Tool in Saudi women with and without type 2 diabetes mellitus: A cross-sectional study

Saudi Med J. 2022 Jul;43(7):700-707. doi: 10.15537/smj.2022.43.7.20220144.


Objectives: To compare the bone mineral density and the fracture risks in Saudi women with and without type 2 diabetes mellitus (T2DM).

Methods: This cross-sectional study was carried out at Taibah Early Diagnostic Center, Al Madinah Al Munawarah, Saudi Arabia. A total of 465 women with and without T2DM aged ≥40 years who visited the center for a dual-energy X-ray absorptiometry scan between December 2020 and July 2021 were randomly selected. The 10-year probabilities of major osteoporotic fracture (MOF) and hip fracture (HF) were calculated using the Abu Dhabi Fracture Risk Assessment Tool (FRAX) with and without adjustment for T2DM. The adjustment was made by setting rheumatoid arthritis as the equivalent risk for T2DM in the FRAX. Bone mineral density values and the FRAX scores were compared between women with T2DM and non-diabetes.

Results: Of 465 women, 214 had T2DM, and 251 were non-diabetics. The mean age of women was 59.42±7.9 years. There were no significant differences in mean age, menopausal status, height, weight, and body mass index between T2DM and non-diabetic women. Bone mineral density values and the unadjusted FRAX scores were comparable between the 2 groups. However, after adjusting FRAX for T2DM, the FRAX for MOF and HF became significantly higher in T2DM women (p=0.000 and p=0.004).

Conclusion: In Saudi women with T2DM, unadjusted FRAX underestimated the risk of MOF and HF. Type 2 diabetes mellitus should be included as one of the clinical risk factors for fracture in future versions of the FRAX score.

Keywords: FRAX; bone density; diabetes mellitus; osteoporosis; type 2 diabetes mellitus.

MeSH terms

  • Absorptiometry, Photon
  • Aged
  • Bone Density
  • Cross-Sectional Studies
  • Diabetes Mellitus, Type 2* / complications
  • Diabetes Mellitus, Type 2* / diagnosis
  • Diabetes Mellitus, Type 2* / epidemiology
  • Female
  • Hip Fractures*
  • Humans
  • Middle Aged
  • Osteoporotic Fractures* / epidemiology
  • Osteoporotic Fractures* / etiology
  • Risk Assessment
  • Risk Factors
  • Saudi Arabia / epidemiology