Hip Fracture Risk in Type 2 Diabetes

Identifying Men Who Benefit from Drug Treatment for Fracture Prevention
Identifying Men Who Benefit from Drug Treatment for Fracture Prevention
The association between risk for hip fracture and diabetes was attenuated after accounting for mortality risk.

The risk for hip fracture associated with diabetes is attenuated when accounting for mortality risk in patients, according toresearch published in the Journal of Clinical Endocrinology & Metabolism.

Emma Hamilton, from the School of Medicine and Pharmacology, University of Western Australia in Crawley, and colleagues analyzed the risk for hip fracture among 1291 patients from the Fremantle Diabetes Study Phase I (FDS1) with type 2 diabetes and compared them with a matched group of 5159 patients without diabetes. Mean age was 64 ± 11.2 years, 48.7% were men, 1.5% of patients (n=19) had been hospitalized for hip fracture prior to the start of the study, and median diabetes duration was 4.0 years.

“[W]e found that the risk of incident hip fracture in our patients with type 2 diabetes was at the lower end of the range found in other studies employing conventional statistical methods, perhaps reflecting the multiracial, population-based nature of the FDS1 cohort and the validated categorization of diabetes type,” Watson and colleagues wrote. “However, the risk of hip fracture in our patients with diabetes was attenuated to nonsignificance after allowing for the competing risk of death.”

The researchers found the first hip fracture incident rate ratio (IRR) was 1.33 (95% CI, 1.05-1.68; P =.013) for patients with type 2 diabetes compared with the control group, with an age-, gender-, and comorbidity-adjusted cause-specific hazard ratio (HR) of 1.50 (95% CI, 1.19- 1.89; P <.001) and subdistribution HR of 1.21 (95% CI, 0.96-1.52; P = 0.11) for patients with type 2 diabetes. Hamilton and colleagues also found that the use of insulin and renal impairment P ≤.015) were associated with cause-specific HRs for incident hip fracture in FDS1 patients, while male gender and body mass index had a protective effect. Aging was associated with significant subdistribution HRs in addition to these variables (P ≤.043).

The researchers noted that study limitations included the lack of measurements for bone turnover markers, related indicators, bone microarchitecture, or bone mineral density in the study, but they said many similar studies also do not contain these data.

“The strengths of the study were its relatively large size and community-based nature, the long follow-up period for incident fractures and mortality ascertained from a well validated data linkage system, and the availability of detailed phenotypic data other than investigations specific to bone health,” said the researchers wrote.

Disclosures: The researchers report no conflicts of interest.

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  1. Hamilton E, Davis WA, Bruce DG, Davis TME. Influence of premature mortality on the link between type 2 diabetes and hip fracture: The Fremantle Diabetes Study [published online November 23, 2016]. J Clin Endocrinol Metab. doi:10.1210/jc.2016-3570.