Introduction: Diabetes mellitus (DM) has been associated with increase in incidence of fracture irrespective of bone mineral density (BMD). There is a paucity of local studies on the relationship of DM, osteoporosis, and fracture. This study aims to compare the osteoporosis risk factors of patients with and without DM admitted for fragility fracture. Methods: This is a retrospective cross-sectional analysis of patients 40 years and above admitted for fragility fracture in Makati Medical Center from January 1, 2015 to December 31, 2017. Results: A total of 132 (32%) patients with DM and 285 patients without DM (non-DM) was reviewed. Mean BMI of DM patients was significantly higher (25.16 kg/m2) compared to non-DM patients (23.27 kg/m2) (P=0.0003). Likewise, presence of comorbidity, specifically hypertension, was significantly higher among DM patients (79.55%) as compared to only 61.75% among non-DM patients (P=0.0003). There was no significant difference found between the two groups in terms of age, gender, proportion of multiple fractures, smoking status, alcohol use, history of fracture and average BMD. Fracture sites were the same for the two groups except in fracture involving finger/toe which was significantly higher in DM patients (P=0.0113). Association between BMI and BMD among DM patients indicate a positive linear relationship (Pearson r of 0.4262) where a higher BMI will likely result to a higher BMD. (P=0.0237). The correlation of HbA1C of DM group patients was noted to have a negative linear relationship with BMD with Pearson r=0.4126 (P= 0.0451). Conclusion Among patients admitted for fragility fracture in Makati Medical Center from 2015 to 2017, clinical profile were similar whether in the DM group or non-DM group except for an increase mean BMI and presence of comorbidity among the DM group. There is also a significant difference in the fracture site according to BMI among both groups. A higher BMI was associated with higher BMD only in patients with DM. Poor glycemic control was associated with lower BMD.
Diabetes Mellitus ; Osteoporosis

Osteonecrosis of the jaw (ONJ) and atypical femoral fracture (AFF) are rare potential adverse effects of bisphosphonates and RANKL antibody therapy. The pathogenic mechanisms of both conditions are known to be independent of each other. Here, we report both conditions sequentially occurring in the same patient.An 81-year-old, obese, diabetic, female was admitted due to hypertensive urgency and persistent jaw pain after tooth extraction. The patient has postmenopausal osteoporosis for fourteen years and was on intermittent, unsupervised treatment with alendronate, denosumab and ibandronate. Upon presentation, the patient was noted with tenderness intraorally of tooth number 35 periapical region. This was associated with elevated erythrocyte sedimentation rate and C-reactive protein. Imaging study showed presence of bony sclerosis which represent a sequestrum in the molar area of the left hemi-mandible. Antibiotic infusion and excision and debridement of left posterior mandible were done. Histopathologic finding was consistent with a diagnosis of osteonecrosis of the jaw. The same patient, upon review, had suffered sequential fracture of both femurs during the eighth and eleventh year of treatment with antiresorptive agents. The fractures were transverse, non-comminuted, at the proximal femoral shaft. Each occurred after a minor trauma and was managed with open reduction and internal fixation. Both fractures were consistent with atypical femoral fractures.ONJ and AFF can occur both in the same patient during prolonged treatment with bisphosphonates and denosumab and may suggest a common pathogenic mechanism.
Osteoporosis