In the Journals

Risk for fracture, post-fracture complications higher in diabetes

Patients with diabetes are at an increased long-term risk for fracture and more prone to adverse events and death after a fracture, according to recent findings.

In two nationwide, retrospective cohort studies, researchers explored the relationships between fracture risk and post-fracture events in patients with diabetes.

In the main analysis, researchers utilized medical claims data from Taiwan’s National Health Insurance Research Database. They identified for analysis 32,471 individuals aged at least 20 years who were diagnosed with diabetes from 2000 to 2003, and who had no history of fracture before initiation of the study. An age- and sex-matched cohort of 64,942 non-diabetic individuals aged at least 20 years during the same period were selected as a non-exposure group. These patients also had no history of fracture before the start of the study. The participants were seen for follow-up beginning in 2000 and were seen through 2008 or until death, loss to follow-up or other causes. The investigators calculated adjusted HRs and 95% CIs to represent the risk for fracture associated with diabetes.

To assess the effect of diabetes on post-fracture adverse events, the researchers also conducted a nested retrospective cohort study. In this analysis, they selected 17,002 patients admitted to the hospital with fractures between 2004 and 2010; 2,971 of these patients had diabetes before fracture and 14,031 did not have diabetes. For this nested study, the researchers compared the rates of septicemia, deep wound infection, pneumonia, urinary tract infection and death for a 30-day period between the pre-fracture diabetes patients and those without pre-fracture diabetes.

The follow-up period equaled 652,530 person-years. During follow-up, the investigators saw that 12,772 cases of fracture were newly diagnosed. The diabetic cohort had a fracture incidence of 24.2 per 1,000 person-years, whereas the non-diabetic group had a fracture incidence of 17.1 per 1,000 person-years (P<.0001). Compared with those without diabetes, patients with diabetes had an adjusted fracture HR of 1.66 (95% CI, 1.6-1.72). There were more post-fracture adverse events in patients with diabetes, whose ORs for various events were as follows: deep wound infection, 1.34 (95% CI, 1.06-1.71); septicemia, 1.42 (95% CI, 1.23-1.64); and mortality, 1.27 (95% CI, 1.02-1.6). There was an increase in mortality associated with poorly controlled diabetes, type 1 diabetes and complications from diabetes.

Although the reason for the association between diabetes and fracture was not identified, the researchers theorized that this could be due to decreases in bone mineral density, increases in cognitive dysfunction or ocular manifestations of diabetes such as retinopathy or cataracts.

“This detailed analysis showed that diabetes is an important independent risk factor for fracture and post-fracture adverse events,” the researchers wrote. “Further studies are needed to develop specific strategies to decrease fracture risks and post-fracture adverse outcomes for this challenging patient population.”

Disclosure: The researchers reported no relevant financial disclosures.

Patients with diabetes are at an increased long-term risk for fracture and more prone to adverse events and death after a fracture, according to recent findings.

In two nationwide, retrospective cohort studies, researchers explored the relationships between fracture risk and post-fracture events in patients with diabetes.

In the main analysis, researchers utilized medical claims data from Taiwan’s National Health Insurance Research Database. They identified for analysis 32,471 individuals aged at least 20 years who were diagnosed with diabetes from 2000 to 2003, and who had no history of fracture before initiation of the study. An age- and sex-matched cohort of 64,942 non-diabetic individuals aged at least 20 years during the same period were selected as a non-exposure group. These patients also had no history of fracture before the start of the study. The participants were seen for follow-up beginning in 2000 and were seen through 2008 or until death, loss to follow-up or other causes. The investigators calculated adjusted HRs and 95% CIs to represent the risk for fracture associated with diabetes.

To assess the effect of diabetes on post-fracture adverse events, the researchers also conducted a nested retrospective cohort study. In this analysis, they selected 17,002 patients admitted to the hospital with fractures between 2004 and 2010; 2,971 of these patients had diabetes before fracture and 14,031 did not have diabetes. For this nested study, the researchers compared the rates of septicemia, deep wound infection, pneumonia, urinary tract infection and death for a 30-day period between the pre-fracture diabetes patients and those without pre-fracture diabetes.

The follow-up period equaled 652,530 person-years. During follow-up, the investigators saw that 12,772 cases of fracture were newly diagnosed. The diabetic cohort had a fracture incidence of 24.2 per 1,000 person-years, whereas the non-diabetic group had a fracture incidence of 17.1 per 1,000 person-years (P<.0001). Compared with those without diabetes, patients with diabetes had an adjusted fracture HR of 1.66 (95% CI, 1.6-1.72). There were more post-fracture adverse events in patients with diabetes, whose ORs for various events were as follows: deep wound infection, 1.34 (95% CI, 1.06-1.71); septicemia, 1.42 (95% CI, 1.23-1.64); and mortality, 1.27 (95% CI, 1.02-1.6). There was an increase in mortality associated with poorly controlled diabetes, type 1 diabetes and complications from diabetes.

Although the reason for the association between diabetes and fracture was not identified, the researchers theorized that this could be due to decreases in bone mineral density, increases in cognitive dysfunction or ocular manifestations of diabetes such as retinopathy or cataracts.

“This detailed analysis showed that diabetes is an important independent risk factor for fracture and post-fracture adverse events,” the researchers wrote. “Further studies are needed to develop specific strategies to decrease fracture risks and post-fracture adverse outcomes for this challenging patient population.”

Disclosure: The researchers reported no relevant financial disclosures.