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. 2013 May;36(5):1153-8.
doi: 10.2337/dc12-1168. Epub 2012 Dec 17.

Diabetes and risk of fracture-related hospitalization: the Atherosclerosis Risk in Communities Study

Andrea L C Schneider  1 , Emma K Williams, Frederick L Brancati, Saul Blecker, Josef Coresh, Elizabeth Selvin
Affiliations

Diabetes and risk of fracture-related hospitalization: the Atherosclerosis Risk in Communities Study

Andrea L C Schneider et al. Diabetes Care. 2013 May.

Abstract

Objective: To examine the association between diabetes, glycemic control, and risk of fracture-related hospitalization in the Atherosclerosis Risk in Communities (ARIC) Study.

Research design and methods: Fracture-related hospitalization was defined using International Classification of Diseases, 9th revision, codes (733.1-733.19, 733.93-733.98, or 800-829). We calculated the incidence rate of fracture-related hospitalization by age and used Cox proportional hazards models to investigate the association of diabetes with risk of fracture after adjustment for demographic, lifestyle, and behavioral risk factors.

Results: There were 1,078 incident fracture-related hospitalizations among 15,140 participants during a median of 20 years of follow-up. The overall incidence rate was 4.0 per 1,000 person-years (95% confidence interval [CI], 3.8-4.3). Diagnosed diabetes was significantly and independently associated with an increased risk of fracture (adjusted hazard ratio [HR], 1.74; 95% CI, 1.42-2.14). There also was a significantly increased risk of fracture among persons with diagnosed diabetes who were treated with insulin (HR, 1.87; 95% CI, 1.15-3.05) and among persons with diagnosed diabetes with hemoglobin A1c (HbA1c) ≥8% (1.63; 1.09-2.44) compared with those with HbA1c <8%. Undiagnosed diabetes was not significantly associated with risk of fracture (HR, 1.12; 95% CI, 0.82-1.53).

Conclusions: This study supports recommendations from the American Diabetes Association for assessment of fracture risk and implementation of prevention strategies in persons with type 2 diabetes, particularly those persons with poor glucose control.

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Figures

Figure 1
Figure 1
Incidence rate (per 1,000 person-years) of hospitalization for fracture according to age and diabetes status. Point estimates are incidence rates per 1,000 person-years for 10-year age intervals. Vertical bars are 95% CIs. Fractures were defined as an ICD-9 discharge code of 733.1–733.19, 733.93–733.98, or 800–829.
See this image and copyright information in PMC

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