AB0819 HANDGRIP STRENGTH PREDICTS HIGH FRACTURE RISK IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Background: Accumulating evidence has revealed that the risk of osteoporosis related fractures is significantly increased in type 2 diabetes mellitus (T2DM) patients in comparison with healthy controls. Dual X-ray Absorptiometry (DXA) derived bone mineral density (BMD) is not completely useful to discriminate at risk patients. Objectives: To find a valuable clinical tool that is helpful to identify 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 dual-energy X-ray absorptiometry (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 to 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 (b= 0.009, SE 0.0034, p=0.01) and femoral neck BMD values (b=0.006, SE 0.002, p=0.01). Age (b= -0.008, SE 0.002, p=0.007) and handgrip strength (b= 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. Conclusion: Handgrip strength may be a reliable tool to screen for bone fragility in T2DM. REFERENCES [1] Napoli N, Chandran M, Pierroz DD et al. Mechanisms of diabetes mellitus-induced bone fragility. Nat Rev Endocrinol 2017; 13(4):208–219. [2] Russo GT, Giandalia A, Romeo EL, Nunziata M, Muscianisi M, Ruffo MC, Catalano A, Cucinotta D. Fracture Risk in Type 2 Diabetes: Current Perspectives and Gender Differences. Int J Endocrinol. 2016;2016:1615735. [3] Li YZ, Zhuang HF, Cai SQ, Lin CK, Wang PW, Yan LS, Lin JK, Yu HM. Low Grip Strength is a Strong Risk Factor of Osteoporosis in Postmenopausal Women. Orthop Surg. 2018 Feb;10(1):17-22.