Type 2 diabetes tied to greater risk for vertebral, nonvertebral fractures

Adults with type 2 diabetes are 55% more likely to sustain an incident vertebral fracture compared with adults without diabetes, with vertebral fracture history further raising the risk for experiencing a nonvertebral fracture, according to findings published in Diabetes Care.

Fernando Rivadeneira

“In contrast to the risk for nonvertebral fractures where type 2 diabetes is a well-established risk factor, studies encountered conflicting results with the risk for vertebral fracture ranging from increased, to no risk or even some studies ­— including ours — finding that individuals with diabetes mellitus were protected against sustaining vertebral fractures,” Fernando Rivadeneira, MD, PhD, an associate professor translational skeletal genomics in the department of internal medicine at Erasmus University Medical Center in Rotterdam, the Netherlands, told Endocrine Today. “By performing the largest meta-analysis combining published results and those using individual-level data, we could establish that there is an increased risk for vertebral fractures in individuals with type 2 diabetes.”

Rivadeneira and colleagues used pooled data from eight studies and seven individual-participant data cohorts (n = 852,705; 58.6% women) and calculated pooled ORs and HRs for prevalent vertebral fractures, incident vertebral fractures, nonvertebral fractures and mortality among adults with type 2 diabetes.

Researchers found no association type 2 diabetes did not increase the risk for prevalent vertebral fractures; however, a lower risk was observed after researchers excluded data from two studies that were the main source of heterogeneity. Researchers found that adults with type 2 diabetes were more likely to experience an incident vertebral fracture vs. adults without the condition (OR = 1.55; 95% CI, 1.04-2.31).

Fracture hip x-ray 2019.  
Adults with type 2 diabetes are 55% more likely to sustain an incident vertebral fracture compared with adults without diabetes, with vertebral fracture history further raising the risk for experiencing a nonvertebral fracture.
Source: Adobe Stock

For adults with type 2 diabetes and a vertebral fracture, nonvertebral fracture risk was higher vs. those who did not have type 2 diabetes or a vertebral fracture (HR = 2.42; 95% CI, 1.86-3.15). For adults with a vertebral fracture who did not have type 2 diabetes, nonvertebral fracture risk was higher vs. those who did not have type 2 diabetes or a vertebral fracture (HR = 1.39; 95% CI, 1.27-1.52). In addition, for adults with type 2 diabetes and no vertebral fracture, nonvertebral fracture risk was higher vs. those who did not have type 2 diabetes or a vertebral fracture (HR = 1.24; 95% CI, 1.09-1.4). The researchers also noted that, among adults who had type 2 diabetes and a vertebral fracture, nonvertebral fracture risk was higher vs. those who had a vertebral fracture but did not have type 2 diabetes (HR = 1.73; 95% CI, 1.32-2.27). In addition, among adults who had type 2 diabetes and a vertebral fracture, nonvertebral fracture risk was higher vs. those who had a vertebral fracture but did not have type 2 diabetes (HR = 1.94; 95% CI, 1.46-2.59).

Compared with the mortality risk among adults who did not have type 2 diabetes or a vertebral fracture, the mortality risk in adults with type 2 diabetes and a vertebral fracture was higher (HR = 2.05; 95% CI, 1.73-2.43). Similarly, compared with the mortality risk among adults who did not have type 2 diabetes but had a vertebral fracture, the mortality risk in adults with type 2 diabetes and a vertebral fracture was higher (HR = 1.71; 95% CI, 1.43-2.03).

“Our study finally closes the uncertainty surrounding the risk for vertebral fractures in individuals with type 2 diabetes; emphasizing to physicians that the risk for osteoporosis and any type fracture in individuals with type 2 diabetes is underestimated by their higher mean BMD levels,” Rivadeneira said. “Our study also highlights that patients with type 2 diabetes who sustain vertebral fractures are at a higher risk for mortality that patients with type 2 diabetes who do not sustain vertebral fractures. While vertebral fractures can be a marker of emerging frailty in individuals with type 2 diabetes, further research is needed to established the underlying mechanisms.” – by Phil Neuffer

Disclosures: Rivadeneira reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

Adults with type 2 diabetes are 55% more likely to sustain an incident vertebral fracture compared with adults without diabetes, with vertebral fracture history further raising the risk for experiencing a nonvertebral fracture, according to findings published in Diabetes Care.

Fernando Rivadeneira

“In contrast to the risk for nonvertebral fractures where type 2 diabetes is a well-established risk factor, studies encountered conflicting results with the risk for vertebral fracture ranging from increased, to no risk or even some studies ­— including ours — finding that individuals with diabetes mellitus were protected against sustaining vertebral fractures,” Fernando Rivadeneira, MD, PhD, an associate professor translational skeletal genomics in the department of internal medicine at Erasmus University Medical Center in Rotterdam, the Netherlands, told Endocrine Today. “By performing the largest meta-analysis combining published results and those using individual-level data, we could establish that there is an increased risk for vertebral fractures in individuals with type 2 diabetes.”

Rivadeneira and colleagues used pooled data from eight studies and seven individual-participant data cohorts (n = 852,705; 58.6% women) and calculated pooled ORs and HRs for prevalent vertebral fractures, incident vertebral fractures, nonvertebral fractures and mortality among adults with type 2 diabetes.

Researchers found no association type 2 diabetes did not increase the risk for prevalent vertebral fractures; however, a lower risk was observed after researchers excluded data from two studies that were the main source of heterogeneity. Researchers found that adults with type 2 diabetes were more likely to experience an incident vertebral fracture vs. adults without the condition (OR = 1.55; 95% CI, 1.04-2.31).

Fracture hip x-ray 2019.  
Adults with type 2 diabetes are 55% more likely to sustain an incident vertebral fracture compared with adults without diabetes, with vertebral fracture history further raising the risk for experiencing a nonvertebral fracture.
Source: Adobe Stock

For adults with type 2 diabetes and a vertebral fracture, nonvertebral fracture risk was higher vs. those who did not have type 2 diabetes or a vertebral fracture (HR = 2.42; 95% CI, 1.86-3.15). For adults with a vertebral fracture who did not have type 2 diabetes, nonvertebral fracture risk was higher vs. those who did not have type 2 diabetes or a vertebral fracture (HR = 1.39; 95% CI, 1.27-1.52). In addition, for adults with type 2 diabetes and no vertebral fracture, nonvertebral fracture risk was higher vs. those who did not have type 2 diabetes or a vertebral fracture (HR = 1.24; 95% CI, 1.09-1.4). The researchers also noted that, among adults who had type 2 diabetes and a vertebral fracture, nonvertebral fracture risk was higher vs. those who had a vertebral fracture but did not have type 2 diabetes (HR = 1.73; 95% CI, 1.32-2.27). In addition, among adults who had type 2 diabetes and a vertebral fracture, nonvertebral fracture risk was higher vs. those who had a vertebral fracture but did not have type 2 diabetes (HR = 1.94; 95% CI, 1.46-2.59).

Compared with the mortality risk among adults who did not have type 2 diabetes or a vertebral fracture, the mortality risk in adults with type 2 diabetes and a vertebral fracture was higher (HR = 2.05; 95% CI, 1.73-2.43). Similarly, compared with the mortality risk among adults who did not have type 2 diabetes but had a vertebral fracture, the mortality risk in adults with type 2 diabetes and a vertebral fracture was higher (HR = 1.71; 95% CI, 1.43-2.03).

“Our study finally closes the uncertainty surrounding the risk for vertebral fractures in individuals with type 2 diabetes; emphasizing to physicians that the risk for osteoporosis and any type fracture in individuals with type 2 diabetes is underestimated by their higher mean BMD levels,” Rivadeneira said. “Our study also highlights that patients with type 2 diabetes who sustain vertebral fractures are at a higher risk for mortality that patients with type 2 diabetes who do not sustain vertebral fractures. While vertebral fractures can be a marker of emerging frailty in individuals with type 2 diabetes, further research is needed to established the underlying mechanisms.” – by Phil Neuffer

Disclosures: Rivadeneira reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.