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

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Abstract

Summary

There is scarce data on the association between early stages of type 2 diabetes and fracture risk. We report a 20 % excess risk of hip fracture in the first years following disease onset compared to matched non-diabetic patients.

Introduction

Type 2 diabetes mellitus (T2DM) is a chronic disease that affects several target organs. Data on the association between T2DM and osteoporotic fractures is controversial. We estimated risk of hip fracture in newly diagnosed T2DM patients, compared to matched non-diabetic peers.

Methods

We conducted a population-based parallel cohort study using data from the Sistema d’Informació per al Desenvolupament de la Investigació en Atenció Primària (SIDIAP) database. Participants were all newly diagnosed T2DM patients registered in SIDIAP in 2006–2011 (T2DM cohort). Up to two diabetes-free controls were matched to each T2DM participant on age, gender, and primary care practice. Main outcome was incident hip fracture in 2006–2011, ascertained using the tenth edition of the International Classification of Diseases (ICD-10) codes. We used Fine and Gray survival modelling to estimate risk of hip fracture according to T2DM status, accounting for competing risk of death. Multivariate models were adjusted for body mass index, previous fracture, and use of oral corticosteroids.

Results

During the study period (median follow-up 2.63 years), 444/58,483 diabetic patients sustained a hip fracture (incidence rate 2.7/1,000 person-years) compared to 776/113,448 matched controls (2.4/1,000). This is equivalent to an unadjusted (age- and gender-matched) subhazard ratio (SHR) 1.11 [0.99–1.24], and adjusted SHR 1.20 [1.06–1.35]. The adjusted SHR for major osteoporotic and any osteoporotic fractures were 0.95 [0.89–1.01] and 0.97 [0.92–1.02].

Conclusions

Newly diagnosed T2DM patients are at a 20 % increased risk of hip fracture even in early stages of disease, but no for all fractures. More data is needed on the causes for an increased fracture risk in T2DM patients as well as on the predictors of osteoporotic fractures among these patients.

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Acknowledgments

DPA, MKJ, CC, and NKA receive partial support from the Oxford NIHR Musculoskeletal Biomedical Research Unit. DPA is funded by the NIHR Clinician Scientist Award scheme.

Conflicts of interest

Daniel Martinez-Laguna, Cristian Tebe, M Kassim Javaid, Xavier Nogues, Nigel K Arden, Cyrus Cooper, Adolfo Diez-Perez, and Daniel Prieto-Alhambra declare that they have no conflict of interest.

Daniel Prieto-Alhambra has received unrelated research grants from AMGEN and BIOIBERICA S.A.

Author information

Authors and Affiliations

  1. GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain

    D. Martinez-Laguna & D. Prieto-Alhambra

  2. Ambit Barcelona, Primary Care Department, Institut Catala de la Salut, Barcelona, Spain

    D. Martinez-Laguna

  3. Universitat Autónoma de Barcelona, Barcelona, Spain

    D. Martinez-Laguna

  4. Agència de Qualitat i Avaluació Sanitàries de Catalunya (AQuAS), Red de Investigación en Servicios de Salud en Enfermedades Crónicas, REDISSEC, Barcelona, Spain

    C. Tebe

  5. MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK

    M. K. Javaid, N. K. Arden, C. Cooper & D. Prieto-Alhambra

  6. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK

    M. K. Javaid, N. K. Arden, C. Cooper & D. Prieto-Alhambra

  7. Internal Medicine Department IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    X. Nogues, A. Diez-Perez & D. Prieto-Alhambra

  8. Musculoskeletal Epidemiology, Botnar Research Centre, Nuffield Orthopaedics Centre, Windmill Road, Oxford, OX3 7LD, UK

    D. Prieto-Alhambra

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  1. D. Martinez-Laguna
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  2. C. Tebe
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  8. D. Prieto-Alhambra
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Correspondence to D. Prieto-Alhambra.

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Martinez-Laguna, D., Tebe, C., Javaid, M.K. et al. Incident type 2 diabetes and hip fracture risk: a population-based matched cohort study. Osteoporos Int 26, 827–833 (2015). https://doi.org/10.1007/s00198-014-2986-9

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  • DOI: https://doi.org/10.1007/s00198-014-2986-9

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