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Large weight loss raises fragility fracture risk in type 2 diabetes

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March 15, 2018

Adults with type 2 diabetes who lost at least 30% of their maximum body weight had increased risks for fragility fractures and any fracture compared with those who lost less weight, according to findings published in Diabetes Care.

Masanori Iwase, MD, PhD, of the department of medicine and clinical science in the Graduate School of Medical Sciences at Kyushu University in Japan, and colleagues evaluated data from the Fukuoka Diabetes Registry on 2,755 men and 1,951 postmenopausal women with type 2 diabetes (mean age, 66 years) to determine the relationship between weight loss and risk for fracture. Follow-up was a median of 5.3 years. Participants were divided into groups based on weight loss from maximum weight: less than 10% (reference group; n = 2,014; 42.5% women), 10% to less than 20% (n = 1,852; 41.1% women), 20% to less than 30% (n = 699; 40.3% women) and at least 30% (n = 141; 37.6% women).

At the end of follow-up, 198 of participants sustained a fragility fracture (55 hip fractures; 144 spine fractures). The incidence rates of fragility fractures were higher in all participants, particularly men, with at least 30% body weight loss (P for trend < .001 for both) compared with the other body weight-loss groups. In postmenopausal women, a similar trend was observed, but it was not statistically significant.

Compared with the reference groups (those who lost < 10% of body weight), the age- and sex-adjusted HRs for fragility fractures for the groups who lost at least 30% body weight were 3.22 (95% CI, 1.85-5.6) in all participants, 6.63 (95% CI, 2.88-15.27) in men and 2.17 (95% CI, 1.02-4.65) in postmenopausal women.

Fractures at any site were sustained by 662 participants (249 in men; 413 in postmenopausal women). The incidence rates for any fracture were higher in the groups that lost at least 30% body weight for all participants (P for trend = .004) and men (P for trend < .001) compared with the other body weight-loss groups. Compared with the reference groups, the age- and sex-adjusted HRs for any fracture for the groups that lost at least 30% body weight were 2.16 (95% CI, 1.53-3.07) in all participants, 2.61 (95% CI, 1.56-4.37) in men and 1.82 (95% CI, 1.13-2.93) in postmenopausal women.

“Our study demonstrates that greater [body weight] loss from maximum [body weight] increases future fracture risk in patients with type 2 diabetes, especially in men,” the researchers wrote. “Although patients with diabetes often lose weight whether intentionally or unintentionally, preventive measures for fragility fractures should be considered in those who lose > 20% of the maximum [body weight].” – by Amber Cox

Disclosures: The authors report no relevant financial disclosures.