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Diabetes May Increase Risk for Major Osteoporotic Fractures

Older patients with diabetes showed a 32% higher major osteoporotic fracture risk than expected given their higher bone mineral density and BMI….

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In an observational study of a dual-energy X-ray absorptiometry (DXA) registry for Manitoba, Canada, Leslie and colleagues looked at 62,413 patients aged at least 40 years undergoing baseline DXA, between 1996 and 2011. The researchers used health services data to identify diabetes diagnosis, Fracture Risk Assessment Tool (FRAX) risk factors and incident fractures through previously validated algorithms.

Over 6 years of follow up, there were 4,218 major osteoporotic fractures and 1,108 hip fractures. The main risk factor for major osteoporotic fractures was diabetes, with adjustments for FRAX risk factors including BMD (HR=1.32; 95% CI, 1.20-1.46). No significant interactions of FRAX risk factors or prior fracture site with diabetes were observed through the analyses. “Older patients with diabetes have 32% higher major osteoporotic fracture risk than expected, given their higher bone mineral density and BMI,” said William Leslie of the University of Manitoba.
For hip fracture prediction, age significantly modified the effect of diabetes:

  • Younger than 60 years, HR=4.67 (95% CI, 2.76-7.89);
  • Aged 60 to 69 years, HR=2.68 (95% CI, 1.77-4.04);
  • Aged 70 to 79 years, HR=1.57 (95% CI, 1.2-2.04);
  • Aged at least 80 years, HR=1.42 (95% CI, 1.1-1.99).

Overall, researchers found that diabetes is an independent risk factor for major osteoporotic fractures, but it does not alter the effect of FRAX risk factors or any prior fracture site. Moreover, the study also suggested that diabetes in younger age patients has a stronger effect on hip fracture risk compared to older patients.

Practice Pearls:

  • Researchers looked at diabetes as a risk factor for major osteoporotic fractures.
  • Study data found that diabetes is an independent risk factor for major osteoporotic fractures, without altering effect of FRAX risk factors or prior fractures.

Leslie WD, et al. “Does diabetes modify the effect of FRAX risk factors for predicting major osteoporotic and hip fracture?” Osteoporos Int. 2014;doi:10.1007/s00198-014-2822-2.