Diabetes Mellitus and Risk of Skeletal Fracture

Heath, Hunter; Melton, L. Joseph; Chu, Ching-Chi

doi:10.1056/nejm198009043031008

Cited by 178 publications

(93 citation statements)

References 14 publications

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“…However, epidemiological studies on the risk of hip fracture among type 1 diabetic patients have usually been of limited sample size, and their results are conflicting. An increased hip fracture risk among postmenopausal women with type 1 diabetes was reported in some (7,8), but not all (9,10), previous investigations. The sparse data that exist regarding men with type 1 diabetes have been unable to confirm any significant excess risks (8,10).…”

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confidence: 74%

Elevated Hip Fracture Risk in Type 1 Diabetic Patients

et al. 2005

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OBJECTIVE -Patients with type 1 diabetes often have low bone mineral density, but epidemiological data on fracture risk are sparse and imprecise, particularly for men. RESEARCH DESIGN AND METHODS -In the Swedish InpatientRegister, we identified a population-based cohort of 24,605 patients (12,551 men and 12,054 women) who were hospitalized for diabetes before age 31 years during 1975 through 1998. Follow-up for hip fracture was accomplished through cross-linkage in the Inpatient Register until the end of 1998. Censoring information was obtained from the registers of Death and Migration. Using the Kaplan-Meier method, we calculated the cumulative probability of getting a hip fracture. Standardized hospitalization ratios and their 95% CIs estimated relative risks with the age-, sex-, and calendar period-matched Swedish general population as reference.RESULTS -In total, 70 and 51 first hip fractures were ascertained in men and women, respectively, corresponding to a cumulative probability (both sexes) of 65.8/1,000 until age 65 years. Markedly elevated risks were observed in both men and women (standardized hospitalization ratios ϭ 7.6 [95% CI 5.9 -9.6] and 9.8 [7.3-12.9], respectively), increasing with follow-up time. Ophthalmic, nephropathic, neurological, and cardiovascular complications were indicators of particularly high risks.CONCLUSIONS -Both male and female type 1 diabetic patients are at increased risk for hip fracture. Although optimal preventive measures still need to be defined, the co-occurrence with other diabetes complications suggests that tighter metabolic control might reduce the risk. Diabetes Care 28:2850 -2855, 2005B oth male and female patients with type 1 diabetes are reported to have low bone mineral density (1-4), one important risk factor for hip fracture (5). Osteopenia may be obvious already in the post-teenage years (6). However, epidemiological studies on the risk of hip fracture among type 1 diabetic patients have usually been of limited sample size, and their results are conflicting. An increased hip fracture risk among postmenopausal women with type 1 diabetes was reported in some (7,8), but not all (9,10), previous investigations. The sparse data that exist regarding men with type 1 diabetes have been unable to confirm any significant excess risks (8,10).The incidence of type 1 diabetes appears to be increasing worldwide (11). With tight metabolic control, drug treatment of hyperlipidemia, and lifestyle modifications, life expectancy among patients with type 1 diabetes is gradually increasing. Accordingly, the prevalence of type 1 diabetes is growing, and many more patients will survive long enough to develop hip fracture. Hip fracture is associated with considerable morbidity and long-term mortality (12), posing a major and growing burden on health care. To quantify the cumulative and relative risk of hip fracture in both male and female type 1 diabetic patients, we performed a nationwide population-based retrospective cohort study in Sweden. RESEARCH DESIGN ANDMETHODS -This stud...

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confidence: 74%

Elevated Hip Fracture Risk in Type 1 Diabetic Patients

et al. 2005

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“…In larger-scale studies, type 1 diabetes increases the risk of fracture, especially in those with microvascular complications [2,14,41] and in females [42,43]. In type 2 diabetes, both lower [44] and higher [1] rates of fracture have been reported, with disease duration and use of insulin increasing the risk [42]. A recent study has reported that type 2 diabetes was a risk factor for hip, proximal humerus and foot fracture despite the presence of high BMD [45].…”

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confidence: 99%

Bone mineral density and its determinants in diabetes: the Fremantle Diabetes Study

et al. 2006

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Aims/hypothesis: We assessed the effects of type 1 and type 2 diabetes on bone density and metabolism.Materials and methods: We analysed bone mineral density (BMD) measured at the hip, spine and forearm using dual energy X-ray absorptiometry in 34 patients with type 1 and 194 patients with type 2 diabetes. Patients were from the community-based Fremantle Diabetes Study, and findings for them were compared with those from normal age-and sex-matched control subjects from the local community. Biochemical and hormonal markers of bone metabolism were measured in a subset of 70 patients. Results: After adjusting for age and BMI, there was a lower BMD at total hip (p<0.001) and femoral neck (p=0.012) in type 1 men vs control subjects, but type 1 women and matched controls had similar BMD at each site. There was a higher BMD at total hip (p=0.006), femoral neck (p=0.026) and forearm (p<0.001) in type 2 women vs control subjects, but diabetes status was not associated with BMD in type 2 men after adjustment for age and BMI. Serum oestradiol, BMI, C-terminal telopeptide of collagen type 1 and male sex were consistently and independently associated with BMD at forearm, hip and femoral neck and explained 61, 55 and 50% of the total variance in BMD, respectively, at these sites. Spine BMD was independently associated with BMI and ln(oestradiol). Conclusions/interpretation: Men with type 1 diabetes may be at increased risk of osteoporosis, while type 2 women appear to be protected even after adjusting for BMI. Low serum oestradiol concentrations may predispose to diabetes-associated osteoporosis regardless of sex.

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“…In contrast, studies in patients with type 2 diabetes have demonstrated that these patients have higher BMD, probably due to increased body weight (8 -10), but have found inconsistent associations between type 2 diabetes and fractures. Some studies have shown no association (11), whereas other cross-sectional studies have demonstrated a decreased risk of fractures in this population (9,12). However, prospective studies have demonstrated that individuals with type 2 diabetes have an increased risk of osteoporotic fractures, particularly of the hip, despite having higher BMD (4 -6,13-16).…”

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The Risk of Hip Fractures in Older Individuals With Diabetes

et al. 2007

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OBJECTIVE -Compared with men and women without diabetes, individuals with type 2 diabetes have higher bone mineral density (BMD). However, they may still be at increased risk for hip fractures. Using population-based Ontario health care data, we compared the risk of hip fractures among men and women with and without diabetes.RESEARCH DESIGN AND METHODS -Using a retrospective cohort design, we identified Ontario residents aged Ն66 years with diabetes from a validated registry from 1994 to 1995 (n ϭ 197,412) and followed them for their first hip fracture until 31 March 2003 (mean 6.1-year follow-up). Hip fracture rates were compared with those of age-matched Ontario residents without diabetes (n ϭ 401,400), and results were stratified by sex and adjusted for age and other covariates.RESULTS -Compared with individuals without diabetes, individuals with diabetes had greater comorbidity, were less likely to have had a BMD test, and were more likely to be taking medications that increase risk of falling and decrease BMD. After adjusting for these differences and age, we found that diabetes increased fracture risk in both men (hazard ratio 1.18 [95% CI 1.12-1.24], P Ͻ 0.0001) and women (1.11 [1.08 -1.15], P Ͻ 0.0001).CONCLUSIONS -Men and women with diabetes have a higher risk of hip fractures compared with individuals without diabetes. Further research to elucidate the mechanisms underlying this increased risk of fracture is needed, as well as increased attention to fracture prevention strategies in patients with diabetes. Diabetes Care 30:835-841, 2007O steoporotic fractures, such as hip and vertebral fractures, are a major source of morbidity and mortality for both men and women. In the 1st year after a hip fracture, there is a 20% increase in mortality, and an estimated 50% of women who sustain a hip fracture do not return to their previous level of function (1).An association between diabetes and hip fractures is becoming increasingly recognized. Both cross-sectional and prospective studies have shown that type 1 diabetes is associated with a decrease in bone mineral density (BMD) (2,3) and an increased risk of osteoporotic hip and other fractures (2,4 -7). In contrast, studies in patients with type 2 diabetes have demonstrated that these patients have higher BMD, probably due to increased body weight (8 -10), but have found inconsistent associations between type 2 diabetes and fractures. Some studies have shown no association (11), whereas other cross-sectional studies have demonstrated a decreased risk of fractures in this population (9,12). However, prospective studies have demonstrated that individuals with type 2 diabetes have an increased risk of osteoporotic fractures, particularly of the hip, despite having higher BMD (4 -6,13-16).Most of these findings have been documented in women (5,6,15). With respect to type 2 diabetes and fracture in men, studies either did not find an association (4,5) or did not specifically examine fracture risk by sex (14,16). Prior studies are also limited by modest sample sizes ...

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Diabetes Mellitus and Risk of Skeletal Fracture

Cited by 178 publications

References 14 publications

Elevated Hip Fracture Risk in Type 1 Diabetic Patients

Elevated Hip Fracture Risk in Type 1 Diabetic Patients

Bone mineral density and its determinants in diabetes: the Fremantle Diabetes Study

The Risk of Hip Fractures in Older Individuals With Diabetes

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