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Association between exercise and risk of fractures in new-onset type 2 diabetes: a retrospective cohort study

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Abstract

Summary

In this population-based retrospective cohort study, exercising before and after the diagnosis of type 2 diabetes was significantly associated with lower risk of fractures. This result suggested that exercising might be effective in reducing fracture risk.

Purpose

Patients with diabetes have a significantly higher risk of fractures. We aimed to investigate the association between exercise and fracture risk in new-onset type 2 diabetes.

Methods

This retrospective cohort study using the Korean National Health Insurance Service database included 170,148 patients with new-onset type 2 diabetes who underwent two cycles of health checkup between 2009–2012 and 2011–2014. The patients were classified into four groups (non-exercising, newly exercising, previously exercising, and continuously exercising) and followed up until the date of fracture, death, or December 31, 2018. Hip fractures, vertebral fractures, and any fractures were defined using diagnostic codes.

Results

The proportions of non-exercising, newly exercising, previously exercising, and continuously exercising patients were 65.1%, 15.7%, 10.9%, and 8.3%, respectively. Continuously exercising patients showed the lowest risk for fractures, followed by newly exercising patients using the non-exercising group as a reference. The adjusted hazard ratios (95% confidence intervals) for hip fracture, vertebral fracture, and any fracture were 0.69 (0.50–0.94), 0.73 (0.63–0.84), and 0.90 (0.83–0.97), respectively, in the continuously exercising group and 0.76 (0.61–0.95), 0.85 (0.76–0.94), and 0.93 (0.88–0.98) in the newly exercising group. The risk was lower in patients who lost less than 5% of their body weight than in those who lost 5% or more.

Conclusion

Exercising was associated with lower risk of fractures in newly diagnosed diabetes. However, exercise accompanied by excessive weight loss may not have a significant association with a lower risk of fractures.

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Data availability

The data presented in this study was available to researchers upon reasonable academic request and with the permission of the Korean NHIS Institutional Data Access (https://nhiss.nhis.or.kr).

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Acknowledgements

National Health Information Database was provided by the National Health Insurance Service (NHIS). The authors would like to thank the NHIS for their cooperation. We would like to thank Harisco for English language editing.

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Author notes

  1. Kyungdo Han and Han Seok Choi contributed equally to this work.

Authors and Affiliations

  1. Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, 27, Dongguk-Ro, Ilsandong-Gu, Goyang-Si, Gyeonggi-Do, Republic of Korea

    Seung Eun Lee, Kyoung-Ah Kim & Han Seok Choi

  2. Department of Biomedicine & Health Science, The Catholic University of Korea, Seoul, Korea

    Juhwan Yoo

  3. Department of Statistics and Actuarial Science, Soongsil University, 369, Sangdo-Ro, Dongjak-Gu, Seoul, Republic of Korea

    Bong-Seong Kim & Kyungdo Han

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  1. Seung Eun Lee
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Correspondence to Han Seok Choi.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Because we used previously collected, publicly available, de-identified data, this study was exempted from ethical review by the Institutional Review Board.

Informed consent

Informed consent was waived because data analyses were performed retrospectively using anonymized data derived from the South Korean NHIS database.

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Lee, S.E., Yoo, J., Kim, BS. et al. Association between exercise and risk of fractures in new-onset type 2 diabetes: a retrospective cohort study. Arch Osteoporos 18, 61 (2023). https://doi.org/10.1007/s11657-023-01240-y

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