Diagnosing Osteoporosis in Diabetes-A Systematic Review on BMD and Fractures

Inge Agnete Gerlach Brandt*, Jakob Starup-Linde, Sally Søgaard Andersen, Rikke Viggers

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review


Purpose of Review
Recently, the American Diabetes Association updated the 2024 guidelines for Standards of Care in Diabetes and recommend that a T-score of − 2.0 in patients with diabetes should be interpreted as equivalent to − 2.5 in people without diabetes. We aimed to evaluate the most recent findings concerning the bone mineral density (BMD)-derived T-score and risk of fractures related to osteoporosis in subjects with diabetes.

Recent Findings
The dual-energy X-ray absorptiometry (DXA) scan is the golden standard for evaluating BMD. The BMD-derived T-score is central to fracture prediction and signifies both diagnosis and treatment for osteoporosis. However, the increased fracture risk in diabetes is not sufficiently explained by the T-score, complicating the identification and management of fracture risk in these patients.

Recent findings agree that subjects with type 2 diabetes (T2D) have a higher T-score and higher fracture risk compared with subjects without diabetes. However, the actual number of studies evaluating the direct association of higher fracture risk at higher T-score levels is scant. Some studies support the adjustment based on the 0.5 BMD T-score difference between subjects with T2D and subjects without diabetes. However, further data from longitudinal studies is warranted to validate if the T-score treatment threshold necessitates modification to prevent fractures in subjects with diabetes.
Original languageEnglish
JournalCurrent Osteoporosis Reports
Issue number2
Pages (from-to)223-244
Number of pages22
Publication statusPublished - Apr 2024

Bibliographical note

© 2024. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.


  • Diabetes type 1
  • Diabetes type 2
  • Diagnosis
  • Fractures
  • Major osteoporotic fracture
  • Osteoporosis


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