Type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN)

Abstract

Objective: This study was conducted to determine if type 1 diabetes is associated with an increased risk of fracture across the life span.

Research design and methods: This population-based cohort study used data from The Health Improvement Network (THIN) in the U.K. (data from 1994 to 2012), in which 30,394 participants aged 0-89 years with type 1 diabetes were compared with 303,872 randomly selected age-, sex-, and practice-matched participants without diabetes. Cox regression analysis was used to determine hazard ratios (HRs) for incident fracture in participants with type 1 diabetes.

Results: A total of 334,266 participants, median age 34 years, were monitored for 1.9 million person-years. HR were lowest in males and females age <20 years, with HR 1.14 (95% CI 1.01-1.29) and 1.35 (95% CI 1.12-1.63), respectively. Risk was highest in men 60-69 years (HR 2.18 [95% CI 1.79-2.65]), and in women 40-49 years (HR 2.03 [95% CI 1.73-2.39]). Lower extremity fractures comprised a higher proportion of incident fractures in participants with versus those without type 1 diabetes (31.1% vs. 25.1% in males, 39.3% vs. 32% in females; P < 0.001). Secondary analyses for incident hip fractures identified the highest HR of 5.64 (95% CI 3.55-8.97) in men 60-69 years and the highest HR of 5.63 (95% CI 2.25-14.11) in women 30-39 years.

Conclusions: Type 1 diabetes was associated with increased risk of incident fracture that began in childhood and extended across the life span. Participants with type 1 diabetes sustained a disproportionately greater number of lower extremity fractures. These findings have important public health implications, given the increasing prevalence of type 1 diabetes and the morbidity and mortality associated with hip fractures.

Figure 1

Overall (A) and hip (B) fracture incidence rates by age and sex in participants with type 1 diabetes compared with participants without diabetes.

Figure 2

Crude HRs for incident overall (A) and hip (B) fracture in participants with type 1 diabetes compared with no diabetes. Participants younger than the age of 30 years were collapsed into one age category for hip fractures due to the low incidence.