Riesgo de fractura asociado a los estadios previos al diagnóstico de diabetes mellitus tipo 2: estudio de casos-controles anidados (cohorte DIAFOS)

Abstract

SummaryBackgound: In phases prior to the diagnosis of diabetes mellitus type 2 there is an increased risk of cardiovascular disease, but it is not known if this is the case in relation to the risk of fractures. Objective: To compare the prevalence of fracture in cases of diabetes mellitus and in matched controls. Material and method: Nested case-control study in a population-based cohort. All patients diagnosed with type 2 diabetes in the period 2006-2011 were included, as were, for each of these patients, two control subjects of the same age, gender, and from the same medical centre, without diabetes. Any fractures, cerebro-vascular accidents and ischemic cardiopathy prevalent in these patients were identified using ICD codes 10. The prevalence of osteoporotic, major and hip fractures, and of cardiovascular disease at the time of diagnosis for the diabetic subjects, and on the same date for the matched controls, were calculated. Using conditional logistical regression the odds ratios (OR) were calculated, adjusting for body mass index, smoking, alcoholism, use of statins, cardiovascular disease and diabetic complications. Results: 58,931 diabetic patients and 117,862 controls were identified. At the date of diagnosis the diabetic patients had a higher prevalence of cerebro-vascular accident (4.9% vs 3.5%; p< 0.001) and ischemic cardiopathy (8.1% vs 4.7%; p< 0.001). On the other hand, the prevalence of osteoporotic fracture (2.8% vs 2.7%; p= 0.22), hip fracture (0.4% vs 0.4%; p=0.63) and major fracture (1.5% vs 1.5%; p=0.97) was similar in both groups. The adjusted ORs were: 1.2 (CI 95%: 0.96-1.09), 1.08 (CI 95%: 0.90-1.28), and 0.99 (CI 95%: 0.91-1.09), respectively. Conclusions: The type 2 diabetic patients had a higher prevalence of cardiovascular disease at the time of diagnosis. However, their risk of fracture was similar to the non-diabetic control subjects.

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

“…In contrast, prediabetes patients (those with impaired glucose tolerance) had a lower fracture risk (hazard ratio (HR)=0.80, 95 % confidence interval (CI) 0.63-1.00). Recently, we also studied this association in the DIAFOS cohort and reported similar fracture risk in pre-diabetic patients compared to non-diabetic patients [9].…”

Los pacientes con diabetes tipo II tienen mayor riesgo de fracturas subsecuentes más allá del periodo de riesgo inminente: un análisis de supervivencia

“…15,16 But there is controversy of the clinical significance of the association of diabetes and risk of fractures. 7,8 Patients with T2DM have shown higher levels of bone mineral density (BMD) than patients of the same age and gender without diabetes, nonetheless there is association with higher risk of osteoporotic fractures in these patients independent of FRAX estimate. [17][18][19] Multivariable Cox proportional hazards models have been previously implemented to establish if diabetes is associated with incident hip fractures or MOF; after controlling age, sex, medication use and FRAX risk fractures including BMD, this analysis failed to identify 10-year probabilities of fracture between diabetic/non diabetic (11.1 ± 7.2 versus non diabetic 10.9 ± 7.3: p = 0.116).…”

“…6 Even though osteometabolic disorders have been described and have been linked to risk of fractures, controversy on the clinical impact of diabetes on fractures persists, and little information has been reported on its impact on subsequent fragility fractures. 7,8 The aim of this study was to establish the impact of previous MOF, age, sex and type 2 diabetes diagnosis on subsequent fractures in patients who sustained an index hip fracture through a survival analysis.…”