T2D Associated With Increased Fracture Risk in Postmenopausal Women

Type 2 diabetes may be associated with an increased risk for a major osteoporotic fracture (MOF) in postmenopausal women, according to study findings published in Endocrine.

A total of 6285 predominantly postmenopausal women referred to an osteoporosis clinic who had average follow-up data up to 5.8 years were included in this analysis. Of these patients, 229 had a diagnosis of type 2 diabetes. Patient data were primarily obtained from a clinical database and Danish national registries.

Fracture risk factors evaluated in this cohort included a family history of fractures, early menopause (<45 years of age without hormone replacement therapy), an approximation of dietary calcium consumption per day (<420, 540-780, and >900 mg/day), use of calcium supplements, exercise <1 times per week, current smoking status, age, body mass index, hyperthyroidism, rheumatoid arthritis, chronic pulmonary disease, prevalent MOF, former osteoporosis treatment, and glucocorticoid use >450 prednisone, among other factors.

Women with diabetes were significantly older than nondiabetic patients (65.3 vs 61.0 years, respectively; P <.0001) and had a higher body mass index (26.6 vs 23.3, respectively; P <.0001). At follow-up, 1734 fractures among 1314 women occurred.

Overall, patients with type 2 diabetes had more prevalent fractures (43.7% vs 33.2%; P =.0010) and more prevalent MOF (26.2% vs 20.5%; P =.038) compared with those without diabetes.

Investigators also observed a higher MOF hazard ratio (HR) when patients with diabetes were compared with patients without diabetes (HR, 1.726; P =.0006), which was sustained even after adjustment for prevalent osteoporosis and other potential confounders (HR, 1.558; P =.0207).

The investigators were unable to adjust for patients’ diabetes severity or success of glycemic control, both of which may influence the risk for fracture. In addition, the investigators did not routinely measure 25-OH vitamin D levels, which could have provided greater insight into bone loss and fracture risk.

To reduce fracture risk, targeted therapy is emphasized, and clinicians are urged “to be aware of and adjust for these findings when evaluating patients with diabetes.”

Reference

Holm JP, Jensen T, Hyldstrup L, Jensen JB. Fracture risk in women with type II diabetes. Results from a historical cohort with fracture follow-up [published online February 16, 2018]. Endocrine. doi:10.1007/s12020-018-1564-x