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HbA1c levels, diabetes duration linked to fracture risk

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Adults with type 2 diabetes and obesity are at increased risk for any fracture, major osteoporotic fractures and hip fractures with longer duration of diabetes and higher HbA1c levels vs. those with shorter duration and lower levels, study data show.

Anna Nilsson, MD, assistant professor at the Institute of Medicine, Sahlgrenska Academy, Gothenburg University in Sweden, and colleagues evaluated linked data from the Swedish National Diabetes Register from 1996 to 2014 on 225,031 adults (mean age, 63 years) with a clinical diagnosis of type 2 diabetes and BMI of at least 30 kg/m² (mean BMI, 34 kg/m²). Researchers also evaluated data from the National Patient Register from 1987 to 2014 to collect information on the incidence of fractures and comorbidities.

Researchers sought to determine predictors of incident fracture in adults with type 2 diabetes and obesity during a mean observation time of 6.5 years.

Overall, 15,314 fractures occurred; 7,674 were major osteoporotic fractures, and 3,651 were hip fractures. In adjusted Cox multivariable analysis, the risk for any fracture was associated with duration of type 2 diabetes (mean, 5.7 years; adjusted HR = 1.012; 95% CI, 1.009-1.014) and HbA1c level (mean, 55 mmol/mol; adjusted HR = 1.004; 95% CI, 1.002-1.005) at baseline. Duration of diabetes at baseline was also associated with the risk for major osteoporotic fracture (HR = 1.013; 95% CI, 1.009-1.017) and hip fracture (HR = 1.018; 95% CI, 1.014-1.023). Further, HbA1c levels at baseline were also associated with the risk for major osteoporotic fracture (HR = 1.003; 95% CI, 1.001-1.005) and hip fracture (HR = 1.003; 1-1.006).

Compared with those in the lowest quartiles of both HbA1c and diabetes duration, participants in the highest quartiles had a higher risk for any fracture (HR = 1.3; 95% CI, 1.16-1.45), major osteoporotic fracture (HR = 1.25; 95% CI, 1.06-1.46) and hip fracture (HR = 1.45; 95% CI, 1.12-1.87).

The role of HbA1c on hip fracture incidence was attenuated after additional adjustment for treatment with insulin, metformin, sulfonylureas, DPP-IV inhibitors and GLP-1 analogues.

According to the researchers, the results “support a multifactorial pathogenesis of bone fragility” in diabetes. – by Amber Cox

Reference:

Nilsson A, et al. Abstract 1127. Presented at: American Society for Bone and Mineral Research Annual Meeting; Sept. 8-11, 2017; Denver.

Disclosure: Nilsson reports no relevant financial disclosures.