Fracture risk in patients with newly diagnosed type 2 diabetes: a retrospective database analysis in primary care

Abstract

Aims: It is unclear whether fracture risk is increased in newly diagnosed type 2 diabetes patients. In addition, fracture risk of various sites (hip, spine, upper extremity) was analysed.

Methods: The study included 299,104 primary care patients from 1,072 practices who received a first type 2 diabetes diagnosis during the index period (01/2000-12/2013) (Disease Analyser, Germany). Furthermore, 299,104 non-diabetic controls were included after individual matching (1:1) to diabetes cases on age, sex, type of health insurance (private or statutory) and index date (visit at date of first diabetes diagnosis). Cumulative incidence of fractures was estimated for 10 years after index date using product-limit methods. Hazard ratios were calculated using Cox regression models adjusting for comorbidity.

Results: Cumulative 10-year incidence of any, hip, spine, wrist/hand, forearm, and upper arm/shoulder fractures were 15.4%, 2.9%, 2.6%, 5.1%, 2.3%, and 2.3% in diabetes patients and 13.1%, 2.0%, 2.1%, 4.6%, 2.2%, and 1.7% in controls (log-rank test: all p<0.001, except wrist/hand p=0.56, forearm: p=0.54), respectively. In multivariate Cox regression models, newly diagnosed type 2 diabetes was related to an significantly increased risk of any fracture (adjusted hazard ratio, HR, 95% CI: 1.36, 1.32-1.40), as well as for hip (1.56, 1.45-1.67), spine (1.37, 1.28-1.47), wrist/hand (1.15, 1.03-1.27), forearm (1.12, 1.05-1.20), and upper arm/shoulder (1.61, 1.49-1.74) fractures.

Conclusions: Already few years after diabetes diagnosis, type 2 diabetes patients more frequently experienced overall, hip, spine, and upper extremity fractures, respectively. The underlying mechanisms need to be further explored in order to prevent fractures among patients with type 2 diabetes.

Keywords: Disease Analyzer; Fracture risk; Osteoporosis; Primary care; Type 2 diabetes.