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BMJ 2011; 342 doi: (Published 08 June 2011) Cite this as: BMJ 2011;342:d3545

T score and FRAX score predict fractures in diabetes

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Older people with type 2 diabetes have an increased risk of fractures but also higher bone mineral density compared with similar people without diabetes. Despite this, it seems that standard scores used to predict risk of bone fracture work for them too. The T score is based on bone mineral density alone, whereas the algorithm used to calculate the FRAX score includes other risk factors, such as age, sex, history of fracture, smoking, drinking, obesity, rheumatoid arthritis, and recent use of steroids.

The data came from three prospective observational studies of older people, with a mean age above 70 years at baseline. Over the follow-up of 12.6 years for women and 7.5 years for men, new hip and non-spinal fractures were recorded by self report and verified by radiology reports.

The T score was as good a predictor of fractures in people with diabetes as in those without. However, for a given T score and age, the risk of fractures was higher in people with diabetes. For example, the diagnostic threshold for osteoporosis in women with diabetes may be as high as −1.9, compared with −2.5 in women without diabetes. Similarly, a man with diabetes and a T score of −2.1 would have a comparable 10 year risk of fracture to a man without diabetes and a T score of −2.5.

The FRAX score also predicted fractures but underestimated the risk in people with diabetes.

No improvement in amputation-free survival with gene therapy in leg ischaemia

Contrary to promising earlier trial phases, a phase 3 trial of gene treatment with non-viral 1 fibroblast growth factor (NV1FGF) for critical limb ischaemia showed no improvement over placebo. The trial recruited 525 patients from 171 centres in 30 countries. All met haemodynamic criteria for critical limb ischaemia and had leg …

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