Diabetes associated with fractures in older male veterans, with comorbidities as mediating factors

The retrospective study involved nearly 2.8 million male veterans 65 to 99 years of age, 32.3% with diabetes, who received primary care at Veterans Health Administration medical centers from 2000 to 2010.


Diabetes was associated with 22% increased risk of hip and any clinical fractures, with a significant proportion explained by neuropathy and heart failure, a study of male veterans ages 65 years and older found.

Researchers conducted a retrospective study of nearly 2.8 million male veterans 65 to 99 years old who received primary care in 146 Veterans Health Administration (VHA) medical centers from 2000 to 2010. More than 900,000 (32.3%) of the men had diabetes. Results appeared online Nov. 1 in the Journal of Clinical Endocrinology & Metabolism.

During the study period, there were 56,905 clinical fractures among older men without diabetes and 25,840 among those with diabetes. There were 7,575 hip fractures among those without diabetes and 3,601 among those with diabetes. The overall fracture rate was 0.117 per 1,000 days at risk: 0.130 per 1,000 days among older men with diabetes compared to 0.111 per 1,000 days among those without diabetes. Common sites of fracture among older men with diabetes included vertebrae, ribs, hips, and lower extremities.

After adjustment for age, race, ethnicity, body mass index, alcohol and tobacco use, rheumatoid arthritis, and corticosteroid use, the relative risk (RR) was 1.22 (95% CI, 1.21 to 1.23) for any clinical fracture associated with diabetes and 1.21 (95% CI, 1.19 to 1.23) for hip fracture.

Significant mediating factors included peripheral neuropathy, cardiovascular disease, and congestive heart failure, with 45.5% of the diabetes-associated fracture risk explained by these diagnoses, the researchers wrote.

Fracture risk was similar between those with diabetes not treated with antihyperglycemic agents (RR, 1.17; 95% CI, 1.16 to 1.18) and those prescribed oral agents only (RR, 1.18; 95% CI, 1.16 to 1.19). The most common oral agents prescribed were sulfonylureas (73.6%), metformin (54.5%), and thiazolidinediones (10.4%). Fracture risk was significantly higher for those prescribed both insulin and an oral agent (RR, 1.40; 95% CI, 1.37 to 1.43) and those prescribed insulin only (RR, 1.54; 95% CI, 1.51 to 1.58).

“Our findings suggest that bone density screening and fracture prevention strategies should be emphasized for patients with comorbid diabetes and heart failure,” the authors concluded.