HANDGRIP STRENGTH TO DISCRIMINATE HIGH FRACTURE RISK IN TYPE 2 DIABETES MELLITUS PATIENTS

Objective: To find a useful clinical tool that identifies type 2 diabetes mellitus (T2DM) subjects with poor bone health, finally preventing fragility fractures. Methods: In a setting of Caucasian subjects with T2DM, anthropometric data and information about metabolic control and diabetic complications were recorded. Handgrip strength by dynamometer, FRAX derived 10-years probability of major osteoporotic fractures and hip fractures were also assessed. Bone evaluation was performed by a DXA densitometer at the lumbar spine (L1-L4) and at the femoral neck; based on specific software, the trabecular bone score (TBS) was calculated. Lateral scan of thoracic and lumbar spine was assessed to investigate morphometric vertebral fractures (Vfx). Results: 29 patients (female 65%) [median age 67 (60-70)] with T2DM were considered. Morphometric vertebral fractures were detected by DXA in 17% of patients without any gender differences (males vs. females, p=0.6). The median ten years probability of fractures was 8.1% and 2.3% as for major osteoporotic or hip fracture respectively. Median femoral neck T-score value [-1.1 SD (-1.8 to -0.5)] was indicative of a slight osteopenia while lumbar spine T-score was even in the normal range [-0.8 SD (-1.5 to -0.1)]. The median TBS value was 1.28 (1.2 to 1.31) and TBS was positively associated with BMD at lumbar spine and femoral neck. Median handgrip strength value was 22.3 kg (18.9 to 31.3). At multiple regression analysis, handgrip strength predicted both lumbar (β=0.009, SE 0.0034, p=0.01) and femoral neck BMD values (β=0.006, SE 0.002, p=0.01). Age (β=-0.008, SE 0.002, p=0.007) and handgrip strength (β=0.01, SE 0.002, p=0.0001) were also independently associated with TBS score, after correcting for mean HbA1c values and time since T2DM diagnosis. Conclusions: These findings suggest that handgrip strength may be a reliable tool to investigate bone fragility in T2DM.