Incident Fracture Risk in Type 2 Diabetic Postmenopausal Women in Mainland China: Peking Vertebral Fracture Study

  • Ruizhi Jiajue
  • Xuan Qi
  • Yan Jiang
  • Qiuping Wang
  • Wenbo Wang
  • Yu Pei
  • Xiran Wang
  • Wei Huang
  • Xin Zheng
  • Zhiwei Ning
  • Ou Wang
  • Mei Li
  • Xiaoping Xing
  • Wei Yu
  • Ling Xu
  • Weibo XiaEmail author
Original Research


Using data from the Peking Vertebral Fracture Study, we conducted a longitudinal cohort study to investigate the association between type 2 diabetes mellitus (T2DM) and the risk of incident fractures, especially of vertebral fractures (VFs), and we also examined the modifying effect of body mass index (BMI) on this association and the effect of bone mineral density (BMD) T-score as a risk factor for incident fractures in T2DM. Chinese postmenopausal women were enrolled (n = 982), among whom 186 had T2DM. Incident VFs were confirmed by lateral radiographs of the thoracolumbar spine (T4–L5), while incident clinical non-VFs were self-reported. BMDs at the lumbar spine (LS) and femoral neck (FN) were measured by dual-energy X-ray absorptiometry. T2DM and non-DM women were at similar risk for VFs (OR 0.74, 95% CI 0.32–1.74), even adjusting for age, BMI, BMD, and previous fractures. Meanwhile, T2DM women had nearly twice the risk for non-VFs (HR 1.95, 95% CI 1.11–3.35) compared with non-DM women. After stratifying by BMI, the risk of VFs remained similar between diabetics and non-diabetics despite their BMI status (p for interaction = 0.470), and the risk of non-VFs was positively associated with T2DM only in women with BMI ≥ 25 kg/m2 (HR 3.59, 95% CI 1.68–7.65) (p for interaction = 0.065). Although LS BMD T-score was similarly and negatively associated with incident VFs both in T2DM (OR 0.34, 95% CI 0.12–0.88) and non-DM women (OR 0.60, 95% CI 0.44–0.82) (p for interaction = 0.430), the FN BMD T-score was not found to be significantly associated with either non-VFs or VFs among T2DM women. Comparing T2DM and non-DM women with similar fracture risks, the mean difference in LS T-score was − 0.36 (95% CI − 1.77 to 1.04) for VF, and difference in FN T-score was 1.61 (95% CI − 0.11 to 3.34) for non-VF. In conclusion, Chinese postmenopausal women with T2DM had a similar risk of incident VFs, but a significantly higher risk of incident non-VF, compared to women without DM. Higher BMI did not modify the effect of T2DM on risk of VFs, but it increased the association between T2DM and risk of non-VFs. LS BMD T-score was similarly and negatively associated with VF risk in T2DM and non-DM women and appear to be useful for clinical evaluation of VF risk.


Type 2 diabetes mellitus Vertebral fractures Bone mineral density Body mass index Peking vertebral fracture stud 



Our deepest gratitude to all the study participants and to the participating centers of the original parent study: Department of Endocrinology, China Rehabilitation Research Center; Department of Endocrinology, Beijing Liangxiang Hospital; Department of Cadre Unit, General Hospital of the Second Artillery Force; Department of Endocrinology, Peking University Shougang Hospital; Department of Endocrinology, Beijing Chaoyang Hospital, Capital University of Medical Science; Department of Endocrinology, Beijing Haidian Hospital; Department of Geriatric Endocrinology, Chinese People’s Liberation Army, General Hospital. We would also like to thank Ms. Yingying Hu for her valuable work in testing biomarker. The Peking Vertebral Fracture Study (PK-VF) was funded by the National Natural Science Foundation of China (No.81070687 and 81170805), National Science and Technology Pillar Program (2006BAI02B03), National Science and Technology Major Projects for “Major New Drugs Innovation and Development” (Grant2008ZX09312-016), Beijing Natural Science Foundation (No. 7121012), Scientific Research Foundation of Beijing Medical Development (No. 2007-3029), and National Key Program of Clinical Science (WBYZ2011-873).

Compliance with Ethical Standards

Conflict of interest

Ruizhi Jiajue, Xuan Qi, Yan Jiang, Qiuping Wang, Wenbo Wang, Yu Pei, Xiran Wang, Wei Huang, Xin Zheng, Zhiwei Ning, Ou Wang, Mei Li, Xiaoping Xing, Wei Yu, Ling Xu, and Weibo Xia declare that they don’t have any conflicts of interest in this work.

Human and Animal Rights and Informed Consent

All of the subjects agreed to participate in this study and signed informed consent forms.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ruizhi Jiajue
    • 1
  • Xuan Qi
    • 1
  • Yan Jiang
    • 1
  • Qiuping Wang
    • 2
  • Wenbo Wang
    • 3
  • Yu Pei
    • 4
  • Xiran Wang
    • 5
  • Wei Huang
    • 6
  • Xin Zheng
    • 7
  • Zhiwei Ning
    • 8
  • Ou Wang
    • 1
  • Mei Li
    • 1
  • Xiaoping Xing
    • 1
  • Wei Yu
    • 9
  • Ling Xu
    • 10
  • Weibo Xia
    • 1
    Email author
  1. 1.Department of Endocrinology, Key Laboratory of Endocrinology, National Commission of Health, Ministry of Health, Peking Union Medical College HospitalChinese Academy of Medical ScienceBeijingChina
  2. 2.Department of EndocrinologyBeijing Liangxiang HospitalBeijingChina
  3. 3.Department EndocrinologyPeking University Shougang HospitalBeijingChina
  4. 4.Department of Geriatric EndocrinologyChinese PLA General HospitalBeijingChina
  5. 5.Department of Cadre UnitGeneral Hospital of the Second Artillery ForceBeijingChina
  6. 6.Department of EndocrinologyBeijing Haidian HospitalBeijingChina
  7. 7.Department of EndocrinologyChina Rehabilitation Research CenterBeijingChina
  8. 8.Department of EndocrinologyBeijing Chaoyang HospitalBeijingChina
  9. 9.Department of Radiology, Peking Union Medical College HospitalChinese Academy of Medical SciencesBeijingChina
  10. 10.Department of Gynaecology and Obstetrics, Peking Union Medical College HospitalChinese Academy of Medical ScienceBeijingChina

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