Type 2 Diabetes and Fracture Risk in Older Women
Authors' conclusion
In this cohort study of older women, T2D was associated with higher BMD, better bone microarchitecture, and no different BMSi but poorer physical function, suggesting that poor physical function is the main reason for the increased fracture risk in T2D women.
Study context
- Population
- Older women aged 75 to 80 years, population-based SUPERB cohort, Gothenburg area, 2013–2016
- Participants
- 3,008 women
- Exposure
- Women with T2D vs women without diabetes
- T2Dn = 294
- Without diabetesn = 2,714reference
- Outcome
- Baseline bone characteristics and physical function, and radiograph-verified incident fractures
Methodological detailspopulation-based, Cox regression adjusted for age, BMI, clinical risk factors and femoral neck (FN) bone mineral density (BMD)
- Population-based
- Cox regression adjusted for age, BMI, clinical risk factors and FN BMD
Main finding
As reported in the abstract
Incident fractures (adjusted Cox regression) · median (IQR) follow-up 7.3 (4.4-8.4) years
T2D vs Without diabetesHazard ratio (95% CI)
Any fracture
1.26(1.04–1.54)
MOF
1.25(1.00–1.56)
- Incident fractures overall
- 1071
- Major osteoporotic fractures (MOF) overall
- 853
- Hip fractures overall
- 232
Observational data: associations, not effects.
Further findings
Mean
| Outcome | T2D | Without diabetes |
|---|---|---|
| Bone material strength index (BMSi), subsample · baseline | 78.0 (SD 8.3) | 78.1 (SD 7.3) |
BMD, T2D vs without diabetes · baseline
- Total hip BMD higher
- 4.4%
- FN BMD higher
- 4.9%
- Lumbar spine BMD higher
- 5.2%
Tibial bone microarchitecture (HR-pQCT), T2D vs without diabetes · baseline
- Greater cortical area
- 7.4%
- Greater cortical density
- 1.3%
- Higher trabecular bone volume fraction
- 8.7%
Bone material strength index (BMSi), subsample · baseline
- No difference in BMSi
Physical function, T2D vs without diabetes · baseline
- Lower grip strength
- 9.7%
- Slower gait speed
- 9.9%
- Slower timed up-and-go time
- 13.9%
- Lower performance on all physical function tests
Original publication
Type 2 Diabetes and Fracture Risk in Older Women. JAMA Netw Open. Published 1 August 2024. doi:10.
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