Epidemiology and correlates of osteoporotic fractures among type 2 diabetic patients
- 378 Downloads
This study analyzed data on 87,224 osteoporotic patients with up to 18 years of computerized medical history. Patients with osteoporosis and type 2 diabetes had higher bone density yet more fractures than non-diabetic osteoporotic patients. Fracture incidence among the diabetic patients was associated with retinopathy and cardiovascular disease, but not with diabetes duration.
Little is known about the association between type 2 diabetes mellitus (T2DM) and fragility fractures or the mechanism(s) involved. We examined fracture correlates among T2DM patients with osteoporosis.
We used electronic health records of an osteoporosis (OP) registry cross-linked with a diabetes registry of a large payer provider healthcare organization in Israel. A cross-sectional analysis compared osteoporosis patients with and without T2DM, and a longitudinal Cox proportional hazard regression was used to identify incident fracture correlates.
As of December 2015 a total of 87,224 current OP patients were identified, of whom 15,700 (18%) had T2DM. The T2DM OP patients were characterized by older age (mean 74.6 vs. 69.5), more males (20.3 vs. 14.0%), and a higher rate of chronic comorbidities compared to OP without diabetes. All major OP fractures (hip, spine, humerus, and forearm) were significantly more prevalent among T2DM OP patients (44 vs. 32%), with an overall age-standardized ratio of 1.22 (95% CI 1.19 to 1.25) and 1.15 (95% CI 1.10 to 1.21) for females and males respectively. The average T-scores were higher (femur neck − 1.8 vs. − 1.9, total hip − 1.2 vs. − 1.6, and vertebrae − 1.3 vs. − 1.7) for the T2DM OP patients compared to the non-T2DM OP patients. Among women with coexisting T2DM and osteoporosis (n = 10,812), fracture incidence was significantly associated with retinopathy (HR = 1.24, 95% CI 1.05 to 1.47) and cardiovascular disease (HR = 1.22, 95% CI 1.10 to 1.36) after controlling for age, bone mineral density T-score, rheumatoid arthritis, glucocorticoids, alcohol, and smoking).
This large population-based study confirms the higher fracture risk of osteoporotic patients with T2DM, as compared to osteoporotic patients without T2DM, despite higher bone mineral density levels. The presence of micro- and macrovascular disease appears to increase this risk.
KeywordsOsteoporosis Type 2 diabetes mellitus Fracture Complications
We are grateful for the assistance of Mrs. Racheli Katz and Cheli Meltzer Cohen in data extraction and Mrs. Esther Eshkol in language editing.
Compliance with ethical standards
Conflicts of interest
Sofia Ish-Shalom has received research grants and consulting, advisory board, lecture fees, and any combination of the three from Merck Sharp & Dohme, Eli Lilly, Enterabio, GlaxoSmithKline, and Novartis. Anne E. dePapp and Allison Martin Nguyen are employees of Merck & Co., Inc. Julie Chandler was an employee of Merck & Co. at the time of this analysis and manuscript preparation. Inbal Goldshtein, Varda Shalev, and Gabriel Chodick declare that they have no conflict of interest.
- 22.Goldshtein I, Chandler J, Shalev V et al (2015) Osteoporosis in the community: findings from a novel computerized registry in a large health organization in Israel. J Aging Res Clin Practice 4:59–65Google Scholar
- 25.Kahn SE, Zinman B, Lachin JM, Haffner SM, Herman WH, Holman RR, Kravitz BG, Yu D, Heise MA, Aftring RP, Viberti G, for the A Diabetes Outcome Progression Trial (ADOPT) Study Group (2008) Rosiglitazone-associated fractures in type 2 diabetes: an Analysis from A Diabetes Outcome Progression Trial (ADOPT). Diabetes Care 31:845–851CrossRefPubMedCentralGoogle Scholar
- 28.Health UDo, Services H (2012) Preventing tobacco use among youth and young adults: a report of the surgeon general. US Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, Atlanta, GA, p 3Google Scholar
- 30.Cohen J (1977) Statistical power analysis for the behavioral sciences, chapter 2: the t test for means. Academic Press, Inc., TorontoGoogle Scholar
- 31.Team RC (2014) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna. 2013Google Scholar
- 36.Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, Jamal SA, Black DM, Cummings SR, Study of Osteoporotic Features Research Group (2001) Older women with diabetes have an increased risk of fracture: a prospective study. The Journal of Clinical Endocrinology & Metabolism 86:32–38CrossRefGoogle Scholar