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Fractures and Type 2 Diabetes

May 11, 2019
 

Author: Steve Freed, R.PH., CDE


Study of fractures and type 2 diabetes found type 2 doubles short-term fracture risk for older women.

The study enrolled 2,105 women and 1,130 men, 9% of whom had T2D (mean age, 67 ± 10 years). Median follow-up was 9 years and was measured until incident fracture, mortality, loss to follow-up, or end of follow-up in 2009. Diagnosis of T2D was more common in men vs women (13% vs 7%), but T2D medication use was more common in women compared with men with T2D (63% vs 51%, respectively). Mean T2D duration was 8 ± 7 years.

Women diagnosed with type 2 diabetes had a more than twofold fracture risk for one year, compared with women without diabetes, according to findings presented at the American Association of Clinical Endocrinologists annual meeting. Researchers also found a 28% increase in fracture risk for each 5-year increase in diabetes duration and a 70% increase in 2-year fracture risk when taking diabetes medications, but no association was found between diabetes and long-term fracture incidence.

Compared with participants without diabetes, each 5 years of diabetes duration increased the 2-year risk for fracture (HR = 1.28; 95% CI, 1.03-1.59) as did use of diabetes medications (HR=1.7; 95% CI, 1.01- 2.85). Researchers found no statistically significant associations between type 2 diabetes and long term fracture incidence. The results showing imminent risk for fracture among older adults with type 2 diabetes imply an opportunity for better risk stratification and clinical intervention, according to the researchers.

In women, T2D was associated with higher cumulative fracture incidence compared with women without T2D (37% vs 30%, respectively). However, in men, cumulative fracture incidence was lower in men with T2D compared with men without T2D (11% vs 16%, respectively). Diagnosis of T2D was associated with more than 2-fold 1-year fracture risk in women (hazard ratio [HR], 2.23; 95% CI, 1.13-4.42), but this association was not present in men.

From the results it was concluded that, with regard to duration of diabetes, the researchers reported a 28% increase in fracture risk for every 5-year increase in T2D duration (HR, 1.28; 95% CI, 1.03-1.59). Use of T2D medications was associated with 70% increase in 2-year fracture risk (HR, 1.70; 95% CI, 1.01-2.85).

Of note, the researchers reported that there was no significant association between T2D and long-term incidence of fracture.

Given an increased imminent risk for fracture in patients with T2D, “clinical intervention may be particularly effective for fracture reduction in older adults with T2D,” concluded the researchers.

Practice Pearls

  • Type 2 diabetes doubles short-term fracture risk for older women.

  • Type 2 diabetes is associated with increased risk for fractures in the short term but not in the long term.

  • Researchers found 28% increase in fracture risk for every 5-year increase in T2D duration.

Dufour A, et al. Diabetes increases short-term but not long-term risk of fracture: A community-based study. Presented at: AACE Annual Scientific and Clinical Congress; April 24-28, 2019; Los Angeles.