Diabetes-related variables, general comorbidities may predict major osteoporotic fractures
A study of African-American, Hispanic, and Caucasian patients with type 1 and type 2 diabetes found that the most significant predictors of fracture risk varied by race and ethnicity.
Risk factors for fracture in patients with diabetes varied by race and ethnicity, comorbidities, and diabetes-specific variables, a retrospective study found.
To evaluate risk factors for incident major osteoporotic fractures of the hip, wrist, and humerus in African-Americans, Hispanic, and Caucasian patients, researchers conducted a retrospective cohort study of 18,210 patients with diabetes at least 40 years of age from a large health care system in Philadelphia. Results were published online March 20 by the Journal of Clinical Endocrinology and Metabolism.
In Caucasian patients, fractures were associated with dementia (hazard ratio [HR], 4.16; 95% CI, 2.13 to 8.12), obstructive sleep apnea (HR, 3.35; 95% CI, 1.78 to 6.29), chronic obstructive pulmonary disease (HR, 2.43; 95% CI, 1.51 to 3.92), and diabetic neuropathy (HR, 2.52; 95% CI, 1.41 to 4.50). In African-American patients, fracture risk was associated with prior fracture (HR, 13.67; 95% CI, 5.48 to 34.1), dementia (HR, 3.10; 95% CI, 1.07 to 8.98), glomerular filtration rate less than 45 mL/min/1.73 m2 (HR, 2.05; 95% CI, 1.11 to 3.79), and long-term steroid use (HR, 5.03; 95% CI, 1.51 to 16.7), while both thiazide use (HR, 0.54; 95% CI, 0.31 to 0.93) and metformin use (HR, 0.59; 95% CI, 0.36 to 0.97) were associated with lower risk. In Hispanic patients, fractures were associated with liver disease (HR, 3.06; 95% CI, 1.38 to 6.79) and insulin use (HR, 2.93; 95% CI, 1.76 to 4.87).
The study authors noted that they included patients only if they had long-term follow-up, which may have created selection bias since people who come to physician appointments may be more diligent about their health, that they could not distinguish between type 1 and type 2 diabetes, and that bone mineral density data were not available for most patients. A strength of the study was that it followed a large, multiethnic population.
Clinicians may want to consider diabetes-related variables as well as general comorbidities when selecting patients for bone mineral density screening and interventions directed at preventing fractures, the authors said.
“While it is now clear that diabetes is associated with an increased fracture risk, there are currently no well-defined guidelines on who with diabetes should be screened or treated for osteoporosis,” the authors wrote. “Our study provides a significant contribution to this important clinical problem.”