Increased Hip Fracture Risk Observed in Diabetics

The risk of hip fracture before the age of 65 is increased to 1 in 15 among both male and female patients with type 1 diabetes.

“Patients with type 1 diabetes often have low bone mineral density, but epidemiological data on fracture risk are sparse and imprecise, particularly for men,” Dr. Weimin Ye and colleagues from Karolinska Institutet, Stockholm, write.

In a population-based, retrospective cohort study, the researchers included a total of 24,605 patients (12,551 men and 12,054 women) in the Swedish Inpatient Register who were hospitalized for diabetes before age 31 years during 1975 through 1998. Cross-linkage in the Inpatient Register until the end of 1998 was used to follow up for hip fracture.

The team obtained censoring information from the death and migration registers. The cumulative probability of getting a hip fracture was calculated using the Kaplan-Meier method. Relative risks with the age-, sex-, and calendar period-matched Swedish general population as reference were estimated using standardized hospitalization ratios (SHR).

The mean and median age at baseline was 20.7 years. Subjects were followed for an average of 9.9 years. A total of 121 incident case of hip fracture, including 51 among women and 70 among men, were recorded during follow-up. Men and women had mean ages at diagnosis of first hip fracture of 41.3 and 43.1 years, respectively. The cumulative probability of hip fracture until age 65 years was 6.6%.

Both men and women had markedly increased risks relative to the general population (SHRS = 7.6 and 9.8, respectively). Risk increased with follow-up time. “Presence of diabetic microvascular (ophthalmic or nephropathic), neurological, or cardiovascular complications indicated excess risks that ranged from 17- to 42-fold,” Dr. Ye’s team writes.

“Given that as many as 1 in 15 patients with type 1 diabetes may sustain a hip fracture before the age of 65, development of methods for primary prevention should be put high on the agenda,” they conclude.

Diabetes Care 28:2850-2855.

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