Fragility fractures remain a major source of morbidity in elderly women with type 2 diabetes mellitus (T2DM), and conventional fracture risk tools may underestimate long-term fracture risk in this population. An ambispective longitudinal cohort study published in BMC Endocrine Disorders evaluated whether the hemoglobin, albumin, lymphocyte, and platelet (HALP) score could improve prediction of fragility fractures and enhance fracture risk assessment when integrated into the fracture risk assessment tool (FRAX).

The study included 423 elderly women with T2DM from multicenter cohorts. Retrospective data were collected between January 2014 and January 2016, followed by prospective follow-up for fragility fracture events through January 2021. Median follow-up duration was 46.8 months. Participants were stratified into low, moderate, and high HALP tertiles.

Findings

• Fragility fractures occurred in 75 of 423 participants (17.73%) during follow-up.
• Lower HALP scores were associated with higher FRAX-estimated 10-year hip fracture probability (FRAX-HF) (r = −0.103; P = 0.037). No significant association was observed with bone mineral density or FRAX-estimated major osteoporotic fracture probability.
• Each one-tertile decrease in HALP score was associated with an approximate 0.31% increase in FRAX-HF probability (β = −0.019; 95% CI, −0.034 to −0.005; P = 0.007).
• In the lowest HALP tertile, FRAX-HF increased from 2.30% to 3.00%, crossing the guideline-recommended threshold for anti-osteoporosis therapy.
• Among non-osteoporotic participants in the lowest HALP tertile, 27.13% (35/129) became eligible for anti-osteoporosis treatment after HALP-adjusted risk assessment.
• Lower HALP scores were associated with higher cumulative fracture incidence over time, while receiver operating characteristic analysis identified a HALP cut-off of 46.77 for fragility fractures (AUC, 0.643; sensitivity, 84.0%; P < 0.001).

The analysis suggested that lower HALP scores may help identify elderly women with T2DM at higher risk of fragility fractures. Incorporating HALP into the FRAX tool also increased identification of patients who met criteria for anti-osteoporosis therapy despite initially falling below standard intervention thresholds.