Bone health

In other news: CGM product review; Skeletal age calculator; Cancer deaths in diabetes

CGM products to be reviewed by Medicare for cost-effectiveness

The government is to review the value of Continuous Glucose Monitoring (CGM) devices subsidised on the NDSS with a cost effectiveness audit overseen by the Medicare Services Advisory Committee. The aim is to ensure that the NDSS’s CGM Initiative which began in April 2017 is clinically and cost effective. The review will cover products such as FreeStyle Libre, Dexcon, Minilink and Guardian devices provided to 58,000 Australians. The deadline for submissions from stakeholders is 12 February.

‘Skeletal age’ calculator predicts fracture risk

A ‘skeletal age calculator that provides, a personalised estimate of an individual’s risk of bone fracture and premature death has been developed by researchers at the Garvan Institute of Medical Research.

The calculator is being made available to health professionals to help better identify individuals at risk of a first bone fracture and to encourage discussions about prevention options.

Its developers say that despite existing models such as the Garvan Fracture Risk Calculator  some individuals do well after an initial fracture while others go on to sustain further fractures and have a higher risk of mortality.

A team led by Professor Tuan Nguyen, Head of the Genetic Epidemiology of Osteoporosis Lab at Garvan used data from Garvan’s Dubbo Osteoporosis Epidemiology Study. Their model incorporates an individual’s age, bone density, history of previous fractures and other health conditions to calculate a personalised estimate of ‘skeletal age’.

“In our new model, we quantified the intricate transitions between fracture, re-fracture and mortality. We define skeletal age as the age of an individual’s skeleton that results from their risk factors for fracture,” said Professor Nguyen.

“Using this definition, we for instance estimated that a typical 70 year old man who had sustained a fracture had a skeletal age of 75 years. But when the man had a second fracture his skeletal age rose to 87 years. This means the individual now has the same fracture risk profile as an 87 year old man who has a healthy risk profile.”

The team is now developing an online calculator, which doctors will be able to use to calculate their patients’ skeletal age.

Cancer deaths overtakes vascular disease in people with diabetes

Large declines in vascular disease death rates among people with diabetes have led to cancer being the leading contributor to the gap in death rates between those with and without diabetes, according to UK research.

Between 2001 and 2018 all-cause mortality rates declined by 32% in men and 31% in women with diagnosed diabetes. Over the same period, the proportion of deaths due to vascular diseases declined from 44% to 24% in individuals with diabetes while deaths due to cancer increased from 22% to 28%.

Writing in Lancet Diabetes and Endocrinology, the researchers said the decline in vascular deaths probably reflected improvements in risk factors such as smoking, hypertension and lipids, as well as targeting of prevention measures in individuals with diabetes. The findings suggested a need to broaden prevention strategies in diabetes to account  for the others causes of death, especially for specific cancers, liver diseases, and dementia, they said.

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