Diabetes does not raise risk for subsequent hip fracture after incident fracture
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Key takeaways:
- The risk for a subsequent hip fracture is similar for adults with or without diabetes.
- Adults with type 1 diabetes have increased risk for a subsequent fracture other than hip fracture.
Older adults with type 1 or type 2 diabetes who sustain an incident hip fracture have a similar likelihood for a subsequent hip fracture as those without diabetes, according to study data published in Bone.
“Among incident hip fracture patients, we found no strong overall association of type 2 diabetes or type 1 diabetes with increased risk of subsequent hip fractures, but diabetes patients with previous hypoglycemic events and those with a history of neuropathy were at clearly increased risk,” Alma B. Pedersen, PhD, DMsc, professor and consultant in the departments of clinical medicine and clinical epidemiology at Aarhus University in Denmark, and colleagues wrote. “In contrast, patients with type 1 diabetes had a clearly increased risk of subsequent fractures other than hip fractures.”
Researchers conducted a population-based nationwide cohort study with data from 92,600 adults aged 65 years and older in Denmark who underwent surgery to treat an incident hip fracture from 2004 to 2018. Data were obtained from five Denmark health registries. Participants with diabetes were diagnosed within 10 years of admission for hip fracture or had obtained at least one prescription for a glucose-lowering drug within 1 year of admission. Adults with type 1 diabetes received insulin monotherapy 1 year before their admission and did not use any other glucose-lowering drugs in the prior 10 years. Information about microvascular diseases was obtained from each participants’ hospital contact history. Researchers obtained data on all subsequent fractures occurring within 2 years of the incident hip fracture.
Of the study group, 12.3% had some form of diabetes. The prevalence of type 1 diabetes among the diabetes group was 11%.
A subsequent hip fracture occurred among 4.8% of adults without diabetes, 4.1% of those with type 2 diabetes and 4.3% of adults with type 1 diabetes in the 2 years after an incident hip fracture. There was no difference in risk for a subsequent hip fracture between the groups.
In sex-stratified analysis, women with type 1 diabetes had higher risk for subsequent fracture than women without diabetes (adjusted HR = 1.52; 95% CI, 1.09-2.11). Adults with type 2 diabetes and a history of hypoglycemia (aHR = 1.75; 95% CI, 1.24-2.47) and those with type 1 diabetes and a history of neuropathy (aHR = 1.73; 95% CI, 1.09-2.75) had higher risk for subsequent hip fracture than people without diabetes.
“The proportion of patients with neuropathy was almost fourfold higher in those with diabetes compared to those without diabetes,” the researchers wrote. “Diabetic neuropathies have been shown to increase the risk of incident fractures in patients with diabetes, which most likely is due to loss in proprioception and increased risk of falling. Further, poorly regulated diabetes and neuropathy increases the likelihood of diabetic foot disease such as foot ulcers, which further have shown to increase the risk of falls.”
Fractures other than hip fractures occurred among 7.3% of adults without diabetes, 6.6% of those with type 2 diabetes and 8.5% of adults with type 1 diabetes. Adults with type 1 diabetes had higher risk for subsequent fracture other than hip fracture compared with those without diabetes (aHR = 1.43; 95% CI, 1.16-1.78).
The researchers noted that the diabetes group included a high percentage of people who used insulin and had some type of microvascular or macrovascular disease.
“More focus should be put toward osteoporosis treatment among diabetes patients in general to prevent both incident and subsequent fractures, and patients with type 2 diabetes could potentially benefit from newer glucose-lowering medications with a lower rate of hypoglycemic events,” the researchers wrote.
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