MON-392 Bone Health in Diabetes - Are We Addressing It?

Abstract

Osteoporosis is a silent disease with decreased bone strength and increased risk of low-trauma fractures. These fractures lead to significant morbidity and mortality and are a major source of medical costs as well as indirect costs from reduced quality of life, disability and death. Calcium and vitamin D (vit D) are important interventions in preventing and treating osteoporosis along with anti-osteoporotic agents. Patients with diabetes mellitus (DM) are at an increased risk of fractures, particularly hip fractures (1). Additionally, bone healing after a fracture is compromised in patients with DM (2). Therefore, addressing bone health can have a significant impact on the well-being of a patient with DM. Optimal management of DM requires a multidisciplinary approach with care that is typically focused on glucose, lipid, and blood pressure management. We hypothesized that bone health may not be addressed consistently in patients with DM due to the need to address these other aspects of their care. We, therefore, conducted a retrospective chart review of patients with DM over the age of 50 with the aim to determine if bone health is being identified and if treatment is being initiated. A total of 100 patients (67 female, 33 male) were studied at the University of New Mexico Diabetes Comprehensive Care Center. Information regarding age, sex, DM type, vit D status and therapy, BMD, and FRAX score were collected. Vit D levels were checked in 68% female and 76% male patients. Mean vit D level was 31.8 ng/ml (reference range 30–100 ng/ml). Low vit D was identified in 33 patients of which only 18% were started on treatment. None of the 10 men identified received treatment for low vit D. BMD was obtained in only 21% of patients even though more than half met criteria for BMD screening based on age alone. Younger women (age < 65y) had more DXA scans performed than older women. Osteoporosis was diagnosed in one female and one male patient. Two female patients over age 65 met criteria for treatment based on FRAX. None of these 4 patients received osteoporosis therapy other than vit D replacement. In conclusion, vit D levels were checked in the majority of our patients indicating that bone health is being considered to some extent. However, low vit D levels were treated in only a minority of women, and in none of the men. Also, none of the patients who met criteria for osteoporosis treatment were started on therapy suggesting a lack of appropriate interventions. Using the results from this study, we plan to improve our clinical practice by incorporating bone health more into the care of our patients with DM, identify those at risk for osteoporosis-related fractures, and institute appropriate interventions. References: 1. Fan Y, Wei F, Lang Y, Liu Y. Osteoporosis Int 2016: 27: 219–228 2. Jiao H, Xiao E, Graves DT. Curr Osteoporosis Rep. 2015 Oct; 13(5): 327 – 335.