REMS & Diabete

The Advantages of REMS Technology in Type 2 Diabetes Mellitus

The study “Utility of REMS-Derived Fragility Score and Trabecular Bone Score in Evaluating Bone Health in Type 2 Diabetes Mellitus” recently published by Al Refaie and colleagues in Diagnostics Journal support the potential of REMS technology as a valuable tool to improve the diagnosis of osteoporosis and the assessment of fracture risk in patients with type 2 diabetes mellitus.

A significantly higher fracture risk characterizes Type 2 diabetes mellitus (T2DM) patients when compared to the non-diabetic population, even though their average bone mineral density (BMD) tends to be normal or high. This elevated risk is primarily driven by defective bone quality. Numerous scientific studies conducted over the past two decades have established that T2DM is associated with an increased risk of fragility fractures, most notably at the hip but also frequently at the wrist and ankle, and that these fractures exert a substantial impact on both quality of life and DALYs in diabetic patients. Evidence further indicates that these fractures frequently occur in patients with normal or even moderately elevated bone mineral density (BMD). This observation highlights that BMD assessment by DXA and common fracture risk algorithms substantially underestimate fracture risk in individuals with T2DM, suggesting that skeletal fragility in this population is primarily attributable to compromised bone quality and impaired microarchitecture rather than to reduced bone mass.

In this study, the authors evaluated for the first time the role of REMS derived parameters (BMD and FS) in a large cohort of male and female patients with T2DM (223 patients vs 102 controls), by comparing them with TBS and BMD values obtained by DXA. 

BMD values for the lumbar spine (LS), femoral neck (FN), and total hip (TH) were obtained via both DXA and REMS. In all patients, TBS and Fragility Score (FS) by REMS were measured and prior major osteoporotic fractures (MOF) were assessed. All BMD T-scores measured by REMS were significantly lower than those obtained by DXA at both lumbar and femoral sites. T2DM patients with previous MOF exhibited lower T-scores for both BMD-LS and BMD-TH, as assessed by DXA and REMS, compared with patients without fractures. However, these differences reached statistical significance for BMD-TH with both techniques and for BMD-LS with REMS, but not for BMD-LS with DXA. Moreover, patients with a history of MOF had significantly lower TBS values (p < 0.05) and significantly higher FS values at both lumbar (p < 0.05) and femoral (p < 0.01) sites compared with those without fractures.

The authors concluded that the parameters obtained using REMS technology (BMD and FS) may be valuable tools for improving the diagnosis of osteoporosis and assessing fracture risk in patients with T2DM.

POST DA PUBBLICARE:

The study “Utility of REMS-Derived Fragility Score and Trabecular Bone Score in Evaluating Bone Health in Type 2 Diabetes Mellitus” recently published by Al Refaie and colleagues in Diagnostics Journal support the potential of REMS technology as a valuable tool to improve the diagnosis of osteoporosis and the assessment of fracture risk in patients with type 2 diabetes mellitus.