Assessment of fracture risk by the FRAX algorithm in men and women with and without type 2 diabetes mellitus: A cross-sectional study

Vincenzo Carnevale, Susanna Morano, Andrea Fontana, Maria Antonietta Annese, Mara Fallarino, Tiziana Filardi, Massimiliano Copetti, Fabio Pellegrini, Elisabetta Romagnoli, Cristina Eller-Vainicher, Volha V. Zhukouskaya, Iacopo Chiodini, Graziella D'Amico

Research output: Contribution to journalArticlepeer-review


Background: The FRAX algorithm is a diffuse tool to assess fracture risk, but it has not been clinically applied in European patients with diabetes. We investigated FRAX-estimated fracture risk in patients with type 2 diabetes mellitus (DM), compared with concomitantly enrolled control subjects. Methods: In our multicentric cross-sectional study, we assessed the FRAX scores of 974 DM and 777 control subjects from three Italian diabetes outpatient clinics, and in DM. We tested the association between parameters and complications of the disease and FRAX scores. Results: DM had significantly lower FRAX-estimated probability of both major osteoporotic fracture (MOF) and hip fracture (HF) than control subjects (6.35±5.07% versus 7.75±6.93%, p1c and hypoglycaemia are significantly associated with FRAX scores; gender-specific regression models differed. Among DM, the tree-based regression (classification and regression tree (CART)) analysis identified groups of patients with different mean FRAX scores. In female DM aged >65years with or without obesity, MOF>20% was found in 5.66% and 13.53% and HF>3% in 40.57% and 63.91% of patients, respectively. Conclusions: Patients with DM had mean FRAX scores lower than control subjects, despite the higher number of previous fractures. Some features and complications of DM did associate with FRAX scores. Among DM patients, the CART analysis identified subgroups with higher FRAX scores. However, despite its potential utility, concerns still remain for using FRAX in DM patients.

Original languageEnglish
Pages (from-to)313-322
Number of pages10
JournalDiabetes/Metabolism Research and Reviews
Issue number4
Publication statusPublished - 2014


  • Classification and regression tree
  • Fractures
  • FRAX
  • Type 2 diabetes

ASJC Scopus subject areas

  • Endocrinology
  • Endocrinology, Diabetes and Metabolism
  • Internal Medicine
  • Medicine(all)


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