RISK FACTORS OF LOW-ENERGY FRACTURES IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Osteoporosis is a metabolic disease of the bone tissue, which is characterized by a violation of the qualitative (microarchitecture change) and quantitative characteristics (decreased bone mass) of the skeleton, and, as a result, lowenergy fractures. The medical and social significance of osteoporosis is due to its consequences: fractures of the femoral neck, vertebral bodies, radius and other large bones of the skeleton, which significantly reduces the quality of patients’ lives and entails significant financial costs for treatment and rehabilitation. Prevalence of diabetes mellitus (DM) significantly increases in all countries of the world, including the Russian Federation. Diabetes and osteoporosis were considered to be individual diseases for a long time. In many prospective large-scale studies it was proved that patients with T2DM have a greater risk of falls and fractures in contrast with the overall population. Despite the increased risk of fractures in diabetic patients, there is still no risk stratification in these patients. The link between the classic risk factors of osteoporotic fractures (such as chronic intake of glucocorticoids, use of alcohol, tobacco, etc.) and the occurrence of fractures is similar in patients with both T2DM and without it. However, it is necessary to take into account other characteristics of diabetes. The specific risk factors of fractures in T2DM patients are duration of the diabetes for more than 10 years, diabetes decompensation, the severity of diabetes, obesity, the frequency of falls, hypoglycemia, insulin, thiazolidinedione, exenatide, sulfonylureas, canagliflozin therapy, and, most likely, the reduction of 25 (OH) vitamin D, functional hypoparathyroidism, the increase of sclerostin, pentosidine, decreased bone mineral density (BMD) of the hip.