Diabetes mellitus and the risk of non-vertebral fractures: the Tromsø study

Abstract

We wanted to determine the risk of non-vertebral fracture associated with type and duration of diabetes mellitus, adjusting for other known risk factors. This is a population-based 6-year follow-up of 27,159 subjects from the municipality of Tromsø, followed from 1994 until 2001. The age range was 25-98 years. Self-reported diabetes cases were validated by review of the medical records. All non-vertebral fractures were registered by computerized search in radiographic archives. A total of 1,249 non-vertebral fractures was registered, and 455 validated cases of diabetes were identified. Men with type I diabetes had an increased risk of all non-vertebral [relative risk (RR) 3.1 (95% CI 1.3-7.4)] and hip fractures [RR 17.8 (95% CI 5.6-56.8)]. Diabetic women, regardless of type of diabetes, had significantly increased hip fracture risk [RR 8.9 (95% CI 1.2-64.4) and RR 2.0 (95% CI 1.2-3.6)] for type I and type II diabetes, respectively. Diabetic men and women using insulin had increased hip fracture risk. Duration of disease did not alter hip fracture risk. An increased risk of all non-vertebral fractures and, especially, hip fractures was associated with diabetes mellitus, especially type I. Type II diabetes was associated with increased hip fracture risk in women only.

Incident type 2 diabetes and hip fracture risk: a population-based matched cohort study

“…However, some studies have suggested that older adults with T2DM might not be protected and even could have a higher risk of hip fractures [5]. Data remain controversial, with a number of authors reporting a lack of association [3,6,7].…”

Diabetes mellitus and risk of hip fractures: a meta-analysis

“…Of these studies, 654 articles were excluded mainly because they did not report outcomes of interest or their findings were not relevant to our metaanalysis. Finally, 21 observational studies [10][11][12][13][14][15][16][17][18][19][20][21][24][25][26][27][28][29][30][31][32] were included in this meta-analysis. A flow chart showing the details of the study selection process is listed in Fig.…”

“…* Y. Liu liuyingzhaozhj@163.com insulin subgroup [16]. Type 1 diabetes is more strongly associated with increased risks of hip fractures than type 2 diabetes [10,11,15,[17][18][19]. By contrast, three studies [20][21][22] did not observe the risk difference between diabetes and non-diabetes.…”

“…Studies on the relationship between diabetes mellitus and risk of hip fractures have yielded inconsistent results. Type 2 diabetic patients have been reported to exhibit increased risks of hip fractures [10][11][12][13], but several studies reported this association in only women [14,15] and an Electronic supplementary material The online version of this article (doi:10.1007/s00198-015-3279-7) contains supplementary material, which is available to authorized users. * Y. Liu liuyingzhaozhj@163.com insulin subgroup [16].…”

The Risk of Hip Fractures in Older Individuals With Diabetes

“…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 and the reliance on survey data for diabetes status, which increases the potential for misclassification because of underreporting (17).…”