Insulin use and Excess Fracture Risk in Patients with Type 2 Diabetes: A Propensity-Matched cohort analysis

Losada-Grande, E; Hawley, Samuel; Soldevila, Berta; Martínez-Laguna, D; Nogués, Xavier; Díez-Pérez, Adolfo; Puig-Domingo, Manel; Mauricio, Dı́dac; Prieto-Alhambra, Daniel

doi:10.1038/s41598-017-03748-z

Cited by 45 publications

(34 citation statements)

References 47 publications

(78 reference statements)

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“…The anabolic effects of insulin seen in experimental studies do not indeed translate into positive effects on bone health in humans (81). A recent population-based study of 58,853 newly diagnosed diabetic patients reported a 38% excess risk of major osteoporotic fractures in those treated with insulin (82).…”

Section: Insulinmentioning

confidence: 99%

The Interplay Between Bone and Glucose Metabolism

et al. 2020

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The multiple endocrine functions of bone other than those related to mineral metabolism, such as regulation of insulin sensitivity, glucose homeostasis, and energy metabolism, have recently been discovered. In vitro and murine studies investigated the impact of several molecules derived from osteoblasts and osteocytes on glucose metabolism. In addition, the effect of glucose on bone cells suggested a mutual cross-talk between bone and glucose homeostasis. In humans, these mechanisms are the pivotal determinant of the skeletal fragility associated with both type 1 and type 2 diabetes. Metabolic abnormalities associated with diabetes, such as increase in adipose tissue, reduction of lean mass, effects of hyperglycemia per se, production of the advanced glycation end products, diabetes-associated chronic kidney disease, and perturbation of the calcium-PTH-vitamin D metabolism, are the main mechanisms involved. Finally, there have been multiple reports of antidiabetic drugs affecting the skeleton, with differences among basic and clinical research data, as well as of anti-osteoporosis medication influencing glucose metabolism. This review focuses on the aspects linking glucose and bone metabolism by offering insight into the most recent evidence in humans.

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Section: Insulinmentioning

confidence: 99%

The Interplay Between Bone and Glucose Metabolism

et al. 2020

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“…Until now, there have been many kinds of hypoglycemic agents with different mechanisms and their effects on the risk of fracture have also been studied. For instance, insulin use appears to be associated with a 38% excess fracture risk among T2DM patients independent of T2DM disease duration [15]. Thiazolidinediones (TZD) have been known to increase the bone loss and risk of fracture, peroxisome proliferator-activated receptor gamma receptor Fig.…”

Section: Introductionmentioning

confidence: 99%

Sulfonylurea and fracture risk in patients with type 2 diabetes mellitus: A meta‐analysis

Zhang

Cao

Tao

et al. 2020

Diabetes Research and Clinical Practice

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“…Previous studies have shown that the risks of fractures in those diagnosed with diabetes were higher than those in non-Hispanic black (HR 1.86 (95% CI 1.05-3.30)) and Mexican American (HR 2.29 (95% CI 1.41-3.73)) adults without diabetes [20]. T2DM factors such as a longer disease duration [21], diabetic complications, poor glycemic control [22], insulin resistance (IR) [23], and the use of insulin or oral antidiabetic medication [19,24] have a complex pathophysiological interaction with fractures. And an increased risk for falls were also reported to increase the fracture risk [25].…”

Section: Discussionmentioning

confidence: 99%

Assessment of Risk Factors for Fractures in Patients with Type 2 Diabetes over 60 Years Old: A Cross-Sectional Study from Northeast China

Guo

Wang

Chen

et al. 2020

Journal of Diabetes Research

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Aims. Previous evidence has demonstrated an increased fracture risk among the population with type 2 diabetes mellitus (T2DM). This study investigated the prevalence of bone fractures in elderly subjects (with and without type 2 diabetes) and identified any fracture risk factors, especially the risk factors for common known fractures in particular diabetic populations. Methods. This cross-sectional study was conducted with community-dwelling people over 60 years old in nine communities from the city of Shenyang, which is the capital of Northeast China's Liaoning Province. A total of 3430 elderly adults (2201 females, mean ± standard deviation age 68:16 ± 6:1 years; 1229 males, 69:16 ± 6:7 years) were included. Our study measured the heel bone mineral density (BMD) and used the timed "up and go" (TUG) test and other indicators. In addition, we performed logistic regression analysis to explore the risk factors for fractures in the general population and the diabetic population and to analyze the differences. Results. The results revealed that a total of 201 elderly persons (5.8%), with an average age of 70:05 ± 6:54 years, suffered from a history of fragility fractures, which affected more females (74.6%) than males (p = 0:001). The prevalence of fractures in the T2DM population was 7.3%, which was much higher than the 5.2% in non-T2DM population (p < 0:05). In the non-T2DM population, the BMD was lower and the TUG time was longer in the fracture group than in the nonfracture group (p < 0:001). However, in the T2DM population, the BMD and TUG values were similar between the fracture group and the nonfracture group (p > 0:05). Logistic regression analysis showed that the female sex (OR 1.835), TUG time > 10:2 s (OR 1.602), and T-score≤−2:5 (OR 1.750) were independent risk factors for fragility fractures in the non-T2DM population, but they were not risk factors in the T2DM population. Conclusions. This study found that low BMD and slow TUG time were independent risk factors for fractures in non-T2DM patients, while no associations were found in the T2DM population. Patients with T2DM have a higher risk for fractures even when they have sufficient BMD and a short TUG time. TUG and BMD underestimated the risk for fractures in the T2DM population.

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Insulin use and Excess Fracture Risk in Patients with Type 2 Diabetes: A Propensity-Matched cohort analysis

Cited by 45 publications

References 47 publications

The Interplay Between Bone and Glucose Metabolism

The Interplay Between Bone and Glucose Metabolism

Sulfonylurea and fracture risk in patients with type 2 diabetes mellitus: A meta‐analysis

Assessment of Risk Factors for Fractures in Patients with Type 2 Diabetes over 60 Years Old: A Cross-Sectional Study from Northeast China

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