Majumdar, S.R., Leslie, W.D., Lix, L.M. et al. (5 more authors) (2016) Longer Duration of Diabetes Strongly Impacts Fracture Risk Assessment: The Manitoba BMD Cohort. The Journal of Clinical Endocrinology & Metabolism, 101 (11). pp. 4489-4496. ISSN 0021-972X
Abstract
Context: Type 2 diabetes is associated with a higher risk for major osteoporotic fracture (MOF) and hip fracture than predicted by the World Health Organization fracture risk assessment (FRAX) tool. Objective: The objective of the study was to examine the impact of diabetes duration on fracture risk. Methods: Using a clinical dual-energy x-ray absorptiometry registry linked with the Manitoba administrative databases, we identified all women age 40 years or older with 10 or more years of prior health care coverage undergoing hip dual-energy x-ray absorptiometry measurements (1996 –2013). Incident MOF and incident hip fractures were each studied over 7 years. Cox proportional hazards models were adjusted for FRAX (FRAX adjusted) and then FRAX plus comorbidity, falls, osteoporosis therapy, or insulin (fully adjusted). FRAX calibration was assessed comparing observed vs predicted probabilities. Results: There were 49 098 women without and 8840 women with diabetes (31.4%10 y duration; 20.1% 5–10 y; 23.7%5 y; 24.8% new onset). In FRAX-adjusted analyses, only duration longer than 10 years was associated with a higher risk for MOF (hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.30 –1.66), and this was similar in the fully adjusted models (HR 1.34, 95% CI 1.17–1.54). In contrast, a higher risk for hip fracture was seen for all durations in a dose-dependent fashion (eg, FRAX adjusted HR 2.10, 95% CI 1.71–2.59 for duration 10 y vs HR 1.32, 95% CI 1.03–1.69 for new onset). FRAX significantly underestimated the MOF risk (calibration ratio 1.24, 95% CI 1.08 –1.39) and hip fracture risk (1.93, 95% CI 1.50 –2.35) in those with a diabetes duration longer than 10 years. Conclusion: Diabetes is a FRAX-independent risk factor for MOF only in women with a long duration of diabetes, but diabetes increases hip fracture risk, regardless of duration. Those with diabetes longer than 10 years are at particularly high risk of fracture, and this elevated risk is currently underestimated by FRAX.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2016 by the Endocrine Society. This article is published under the terms of the Creative Commons Attribution-Non Commercial License (CC-BY-NC; http://creativecommons.org/licenses/by-nc/4.0/). |
Keywords: | diabetes mellitus; type 2; fracture; hip fractures; manitoba; osteoporotic fracture risk; world health organization frax osteoporotic fracture probability assessment tool |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) > Division of Genomic Medicine (Sheffield) > Department of Oncology and Metabolism (Sheffield) The University of Sheffield > Sheffield Teaching Hospitals |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 21 Apr 2017 11:05 |
Last Modified: | 21 Apr 2017 11:05 |
Published Version: | https://doi.org/10.1210/jc.2016-2569 |
Status: | Published |
Publisher: | Endocrine Society |
Refereed: | Yes |
Identification Number: | 10.1210/jc.2016-2569 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:115138 |