Incident Type 2 Diabetes and Risk of Fracture: A Comparative Cohort Analysis Using U.K. Primary Care Records

Davie, Gabrielle S.; Pal, Kingshuk; Orton, Elizabeth; Tyrrell, Edward G.; Petersen, Irene

Abstract

Objective: To estimate risk of fracture in men and women with recent diagnosis of type 2 diabetes compared to individuals without diabetes.

Research Design and Methods: In this cohort study we used routinely-collected UK primary care data from The Health Improvement Network. In adults (>35 years) diagnosed with type 2 diabetes between 2004-2013 fractures sustained until 2019 were identified and compared to fractures sustained in individuals without diabetes. Multivariable models estimated time to first fracture following diagnosis of diabetes. Annual prevalence rates included at least one fracture in a given year.

Results: Among 174,244 individuals with incident type 2 diabetes and 747,290 without diabetes, there was no increased risk of fracture among males with diabetes (adjusted hazards ratio (aHR) 0.97 (95%CI 0.94, 1.00)) and a small reduced risk among females (aHR 0.94, (95%CI 0.92, 0.96)). In those aged 85 years and over those in the diabetes cohort were at significantly lower risk of incident fracture (Males: aHR 0.85, 95%CI 0.71, 1.00; Females: aHR 0.85, 95%CI 0.78, 0.94). For those in the most deprived areas, aHRs were 0.90 (95%CI 0.83, 0.98) for males and 0.91 (95%CI 0.85, 0.97) for females. Annual fracture prevalence rates, by sex, were similar for those with and without type 2 diabetes.

Conclusion: We found no evidence to suggest a higher risk of fracture following diagnosis of type 2 diabetes. After a diagnosis of type 2 diabetes individuals should be encouraged to make positive lifestyle changes, including undertaking weight-bearing physical activities that improve bone health.

• Journal Article Type: Article
• Acceptance Date: Sep 30, 2020
• Online Publication Date: Nov 4, 2020
• Publication Date: Jan 1, 2021
• Deposit Date: Nov 26, 2020
• Publicly Available Date: Nov 26, 2020
• Journal: Diabetes Care
• Print ISSN: 0149-5992
• Electronic ISSN: 1935-5548
• Publisher: American Diabetes Association
• Peer Reviewed: Peer Reviewed
• Volume: 44
• Issue: 1
• Pages: 58-66
• DOI: https://doi.org/10.2337/dc20-1220
• Keywords: Advanced and Specialized Nursing; Endocrinology, Diabetes and Metabolism; Internal Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/4978074
• Publisher URL: https://care.diabetesjournals.org/content/44/1/58
• Additional Information: This is an author-created, uncopyedited electronic version of an article accepted for publication in Diabetes Care. The American Diabetes Association (ADA), publisher of Diabetes Care, is not responsible for any errors or omissions in this version of the manuscript or any version derived from it by third parties. The definitive publisher-authenticated version will be available in a future issue of Diabetes Care in print and online at http://care.diabetesjournals.org.