Diabetic bone disease or secondary osteoporosis is now recognised as a complication of diabetes. It predisposes patients with diabetes to bone fragility and increased risk of fracture. Around 20% of patients with type 2 diabetes exhibit bone loss which can be defined as osteoporosis.¹ Whether prediabetes confers a similar risk of fracture is still not well understood.

To find an answer to this question, a team of American researchers collected data of 1690 middle-aged women of multiple ethnicities who were in premenopause or early perimenopause at the time of their enrolment and had prediabetes before menopausal transition.² None of them were taking bone-beneficial medications before they attained menopause. The mean body mass index (BMI) at the start of the menopausal transition was 27.6. These women had participated in the multicenter “Study of Women’s Health Across the Nation (SWAN)” trial.

Time to first fracture after the start of the MT, with censoring at first diagnosis of type 2 diabetes was the main outcome measure.

According to results published in JAMA Network Open, most of the (86.7%, n=1465) women did not have prediabetes before menopause and just ~14% (n = 225) of them were prediabetic before menopause.2 Twenty-five women with prediabetes suffered an incident fracture, while in the non-prediabetes group, 111 (7.6%) women had a fracture. After adjustment for factors such as race/ethnicity, use of bone-detrimental medicines, age, BMI, cigarette smoking at menopause, women who had prediabetes before they attained menopause were twice more likely to experience a fracture later on with HR of 2.20. This association remained significant after controlling for BMD at the start of the menopausal transition.

This study shows a statistically significant association of prediabetes with high risk of fracture, which was independent of BMD at the start of the menopausal transition, and suggests prediabetes as a risk factor for fracture among women in midlife. Whether treatment of prediabetes would reduce this risk is a subject of further research, note the authors.

References

1. Wu B, et al. A narrative review of diabetic bone disease: Characteristics, pathogenesis, and treatment.Front Endocrinol (Lausanne). 2022 Dec 14;13:1052592. doi: 10.3389/fendo.2022.1052592.
2. Shieh A, et al. Prediabetes and fracture risk among midlife women in the Study of Womens Health Across the Nation. JAMA Netw Open. 2023 May 1;6(5):e2314835. doi: 10.1001/jamanetworkopen.2023.14835.