LOS ANGELES — Older adults with type 2 diabetes, particularly those with longer disease duration and those taking diabetes medications, had increased 1- and 2-year fracture risks vs. adults without diabetes, but the risks evened out by 10 years, according to study results presented at the AACE Annual Scientific and Clinical Congress.
Researchers found that among participants from the Framingham Original and Offspring Cohorts, fracture risk doubled at 1 year for women with vs. without type 2 diabetes.
Elizabeth J. Samelson
“Typically, you need to follow people forward for a long period of time to accrue enough fractures to do your study,” principal investigator Elizabeth J. Samelson, PhD, associate scientist at the Marcus Institute for Aging Research at Hebrew SeniorLife and assistant professor at Harvard Medical School, told Endocrine Today. “But because of the incredible size and characterization of the Framingham cohorts, we were able to look at fracture risks over 1 year and 2 years as well as over 10 years. What we found was that having diabetes increased the short-term risk of fracture over 1 to 2 years ... whereas over the 10 years — when you look out over the long term — the increased risk in diabetics was not significant.”
Researchers assessed data from the Framingham Original and Offspring Cohorts for 2,105 women and 1,130 men (mean age, 67 years) who had a baseline osteoporosis study examination around 1990. Among the cohort, 7% women and 13% men had type 2 diabetes (mean duration, 8 years); of these, 63% of the women and 51% men reported taking medication for the disease.
During a median follow-up of 9 years, 37% of women and 11% of men with type 2 diabetes experienced a fracture vs. 30% of women and 16% of men without diabetes. At 1 year, the risk for fracture among women with vs. without type 2 diabetes was more than doubled (HR = 2.23; 95% CI, 1.13-4.42).
Older adults with type 2 diabetes, particularly those with longer disease duration and those taking diabetes medications, had increased 1- and 2-year fracture risks vs. adults without diabetes.
“Ever since we discovered that smoking causes lung cancer, we don’t typically see hazard ratios that high,” Samelson said.
Compared with participants without diabetes, each 5 years of diabetes duration increased the 2-year risk for fracture (HR = 1.28; 95% CI, 1.03-1.59) as did use of diabetes medications (HR=1.7; 95% CI, 1.01-2.85). Researchers found no statistically significant associations between type 2 diabetes and long-term fracture incidence.
The results showing imminent risk for fracture among older adults with type 2 diabetes imply an opportunity for better risk stratification and clinical intervention, according to the researchers
“Our next steps will be to look at specific medication use, to look at different markers of disease severity, and to look at other risk factors for fracture in diabetics,” Samelson said. – by Jill Rollet
Dufour A, et al. Diabetes increases short-term but not long-term risk of fracture: A community-based study. Presented at: AACE Annual Scientific and Clinical Congress; April 24-28, 2019; Los Angeles.
Disclosures: The grant for this study was funded through Radius Health. Samelson reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.