Type 2 diabetes mellitus (T2DM) is associated with an increased risk of fractures according to several studies. The underlying mechanisms remain unclear, although small case-control studies indicate poor quality of the cortical bone. We have studied a population-based sample of women aged 75 to 80 years in Gothenburg, randomly invited from the population register. Areal bone mineral density (aBMD) was measured by dual-energy X-ray absorptiometry (Hologic Discovery A), bone microarchitecture by high-resolution peripheral quantitative computed tomography (HR-pQCT; ExtremeCT from Scanco Medical AG), and reference point indentation was performed with Osteoprobe (Active Life Scientific). Women with T2DM (n ¼ 99) had higher aBMD compared to controls (n ¼ 954). Ultradistal tibial and radial trabecular bone volume fraction (þ11% and þ15%, respectively), distal cortical volumetric BMD (þ1.6% and þ1.7%), cortical area (þ11.5% and þ9.3%), and failure load (þ7.7% and þ12.9%) were higher in diabetics than in controls. Cortical porosity was lower (mean AE SD: 1.5% AE 1.1% versus 2.0% AE 1.7%, p ¼ 0.001) in T2DM in the distal radius but not in the ultradistal radius or the tibia. Adjustment for covariates (age, body mass index, glucocorticoid treatment, smoking, physical activity, calcium intake, bone-active drugs) eliminated the differences in aBMD but not in HR-pQCT bone variables. However, bone material strength index (BMSi) by reference point indentation was lower in T2DM (74.6 AE 7.6 versus 78.2 AE 7.5, p < 0.01), also after adjustment, and women with T2DM performed clearly worse in measures of physical function (one leg standing: -26%, 30-s chair-stand test: -7%, timed up and go: þ12%, walking speed: þ8%; p < 0.05-0.001) compared to controls. In conclusion, we observed a more favorable bone microarchitecture but no difference in adjusted aBMD in elderly women with T2DM in the population compared to nondiabetics. Reduced BMSi and impaired physical function may explain the increased fracture risk in T2DM.

Questions remain about whether the increased risk of fractures in patients with type 2 diabetes (T2DM) is related mainly to increased risk of falling or to bone-specific properties. The primary aim of this study was to investigate the risk of hip fractures and non-skeletal fall injuries in older men and women with and without T2DM. ) predicted non-skeletal fall injury. The same pattern was found regarding other fractures (any, upper arm, ankle, and major osteoporotic fracture) but not for wrist fracture. Subset analyses revealed that in men, the risk of hip fracture was only increased in those with T2DM-I, but in women, both the diagnosis of T2DM-O and T2DM-I were related to increased hip fracture risk. In conclusion, the risk of fractures differs substantially among patients with T2DM and an increased risk of hip fracture was primarily found in insulin-treated patients, whereas the risk of non-skeletal fall injury was consistently increased in T2DM with any diabetes medication.

OBJECTIVE -Previously undetected glucose abnormalities are common in patients with acute myocardial infarction (AMI). We evaluated long-term reliability of early glucometabolic classification of patients with AMI by repeated oral glucose tolerance tests (OGTTs). RESEARCH DESIGN AND METHODS-A glucometabolic OGTT-based classification was obtained in 122 patients by measuring capillary whole-blood glucose. The classification was performed on three occasions, before hospital discharge and 3 and 12 months thereafter.RESULTS -At discharge, 34, 31, and 34% were classified as having normal glucose tolerance, impaired glucose tolerance (IGT), or type 2 diabetes, respectively, and 93% of all patients with type 2 diabetes were still classified with type 2 diabetes (n ϭ 27) or IGT (n ϭ 12) after 12 months. The agreements between the OGTTs at discharge and 3 and 12 months were ϭ 0.35, P Ͻ 0.001, and ϭ 0.43, P Ͻ 0.001, respectively. CONCLUSIONS -The outcome of an OGTT performed in AMI patients at hospital discharge reliably informs on long-term glucometabolic state. Diabetes Care 31:36-38, 2008I n recent years, focus has been devoted to the high prevalence of previously undiagnosed glucose abnormalities in patients with acute myocardial infarctions (AMIs) as reported by the GAMI (Glucose tolerance in Acute Myocardial Infarction [1]) Study and subsequently confirmed by the Euro and China Heart Surveys (2,3). These findings attracted further attention when it recently became evident that postinfarction patients with newly detected disturbed glucose metabolism are at an increased risk for cardiovascular morbidity and mortality (4,5), emphasizing the importance of diagnosing these patients at an early stage.Classification of glucose abnormalities should, according to the World Health Organization (WHO) (6), be based on fasting and postload plasma glucose obtained by a standardized oral glucose tolerance test (OGTT), while the most recent American Diabetes Association (ADA) criteria (7) includes fasting blood glucose only. The latter method will, however, identify only about onethird of individuals defined with newly detected diabetes by means of an OGTT (1,8,9).This analysis from the GAMI Study aimed at investigating the long-term reliability of early classification of glucose abnormalities using OGTT in patients with AMI without previously known type 2 diabetes. RESEARCH DESIGN ANDMETHODS -A detailed description of the GAMI Study has been presented elsewhere (1). The inclusion criteria were suspected AMI, no previously known diabetes, baseline capillary blood glucose Ͻ11.1 mmol/l, serum creatinine Ͻ200 mol/l, and age Յ80 years. A total of 181 participants were enrolled, of whom 168 were characterized on discharge after an OGTT as having normal glucose tolerance (NGT), impaired glucose tolerance (IGT), or type 2 diabetes. The present report is based on the 122 patients, who at all occasions during follow-up (discharge and 3 and 12 months) could be reclassified into the three groups.A standardized OGTT (75-g glucose in 200 ml wate...