medwireNews: Findings from a Swedish national cohort study published in PLOS Medicine suggest that type 2 diabetes is not an important risk factor for fracture, as this risk is only “marginally” increased in people with the condition.
For the study, Mattias Lorentzon (University of Gothenburg, Sweden) and co-authors included data from 580,127 adults with type 2 diabetes (mean age 66.7 years, 43.6% women) and the same number of controls without diabetes who were matched for age, sex, and county from 2007 to 2017. During a median follow-up of 6.6 years, 13.0% of individuals with diabetes had a fracture, compared with the 12.3% in the control group, corresponding to incidence rates of 22.2 and 21.1 per 1000 person–years, respectively.
The researchers found that participants with diabetes had a “marginally” but significantly increased risk for any fracture, major osteoporotic fracture, and hip fracture compared with controls, at hazard ratios of 1.05, 1.01, and 1.06, respectively. These associations were only minimally affected by adjustment for confounders like age, sex, marital status, fracture risk, and other general morbidity and cardiovascular status factors.
In a multivariable analysis, the proportion of the risk for all fracture outcomes due to type 2 diabetes was below 0.1%. Among people with diabetes, BMI below 25 kg/m2, long diabetes duration, insulin treatment during the prior year, and low physical activity were the most important independent diabetes-related risk factors for fracture.
People with diabetes who had at least two of these risk factors had a 20% or more increased risk for fracture compared with their control counterparts. However, Lorentzon et al note that, overall, only 14% of the individuals with diabetes had at least two risk factors. More than half of people with diabetes had none of these risk factors, “and therefore a small but significantly lower fracture risk than their respective controls.”
Considering the risk factors identified in the study could be used to stratify people with type 2 diabetes with “a clinically relevant increased fracture risk,” writes the team.
They conclude: “Further studies are needed to develop fracture risk calculators for different settings and populations for [type 2 diabetes] patients specifically.”
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PLoS Med 2023; doi:10.1371/journal.pmed.1004172