Adjusting fracture probability according to duration of diabetes: the Manitoba BMD Registry
Authors' conclusion
Diabetes was associated with incident MOF and hip fracture independent of baseline fracture probability, but this risk was partially offset by excess mortality. TBS adjustment and RA input showed complementary benefits for improving fracture prediction that differed according to diabetes duration and fracture outcome.
Study context
- Population
- Individuals aged ≥ 40 years from the Manitoba Bone Density Program with FRAX-based probability and trabecular bone score (TBS) measurements (mean age 63.8 years, 89.9% female), including 5274 (9.7%) with diabetes5,274 (9.7%) with diabetes
- Participants
- 54,609 individuals
- Exposure
- FRAX with rheumatoid arthritis (RA) input and/or TBS adjustment vs unadjusted FRAX, to capture FRAX-independent risk associated with diabetes
- Outcome
- Incident MOF and hip fracture
- Follow-up
- Mean 9.6 years observation
Methodological detailsregistry-based, Cox regression, Fine-Gray regression with competing mortality
- Registry-based
- Cox regression
- Fine-Gray regression with competing mortality
Main finding
As reported in the abstract
- Major osteoporotic fracture (MOF), diabetes duration <5 years: no FRAX adjustment required
- MOF, duration 5-10 years: FRAX adjusted with TBS slightly better than unadjusted FRAX
- MOF, duration >10 years: larger effect from RA input beneficial, with or without TBS
- Hip fracture: risk consistently greater regardless of diabetes duration; required TBS, with or without RA
Observational data: associations, not effects.
Further findings
Incident fractures in cohort · mean 9.6 years
- Incident MOF
- 5723, 10.5%
- Incident hip fractures
- 1715, 3.1%
Original publication
Adjusting fracture probability according to duration of diabetes: the Manitoba BMD Registry. Osteoporos Int. Published 10 April 2026. doi:10.
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