Abstract
Although type 2 diabetes mellitus (T2DM) has been associated with an increase in fracture risk, there is no data regarding the prevalence of vertebral fractures or its risk factors for patients with T2DM in Korea. In this cross-sectional study, we recruited postmenopausal women with T2DM from 24 tertiary hospital diabetes clinics in Korea. Prevalent vertebral fractures were identified on lateral spinal radiographs of thoracolumbar vertebrae by vertebral morphometry. Demographic and biochemical characteristics related to diabetes were obtained, and bone mineral density of the lumbar spine and femoral neck, which was available in 752 (33.6 %) and 675 (30.1 %) patients, respectively, was also analyzed. Of the 2239 subjects recruited (mean age 63.9 years), a total of 970 (43.3 %) subjects had vertebral fractures. In the bivariate analysis, history of fragility fractures after 50 years of age, microalbuminuria, presence of cardiovascular disease (myocardial infarction, angina, cerebrovascular complications of cardiovascular disease), and presence of osteoporosis at the total hip were significantly associated with the presence of vertebral fractures, after adjusting for age. In the multivariate analysis, the presence of cardiovascular diseases in addition to advancing age and history of fragility fractures was significantly associated with increased odds of vertebral fractures. Vertebral fractures were highly prevalent in postmenopausal women with T2DM in this study conducted in Korea, and the presence of cardiovascular disease, in addition to older age and history of fragility fractures, was significantly associated with the presence of vertebral fractures.
Similar content being viewed by others
References
Chan JC, Malik V, Jia W, Kadowaki T, Yajnik CS, Yoon KH, Hu FB (2009) Diabetes in Asia: epidemiology, risk factors, and pathophysiology. JAMA 301:2129–2140
Ramachandran A, Ma RC, Snehalatha C (2010) Diabetes in Asia. Lancet 375:408–418
Yoon KH, Lee JH, Kim JW, Cho JH, Choi YH, Ko SH, Zimmet P, Son HY (2006) Epidemic obesity and type 2 diabetes in Asia. Lancet 368:1681–1688
http://www.hira.or.kr/ICSFiles/afieldfile/2011/02/11/a.hwp(Korean) (2011)
Schwartz AV (2003) Diabetes mellitus: does it affect bone? Calcif Tissue Int 73:515–519
Hofbauer LC, Brueck CC, Singh SK, Dobnig H (2007) Osteoporosis in patients with diabetes mellitus. J Bone Miner Res 22:1317–1328
Melton LJ 3rd, Leibson CL, Achenbach SJ, Therneau TM, Khosla S (2008) Fracture risk in type 2 diabetes: update of a population-based study. J Bone Miner Res 23:1334–1342
Inzerillo AM, Epstein S (2004) Osteoporosis and diabetes mellitus. Rev Endocr Metab Disord 5:261–268
Leidig-Bruckner G, Ziegler R (2001) Diabetes mellitus a risk for osteoporosis? Exp Clin Endocrinol Diabetes (official journal, German Society of Endocrinology German Diabetes Association) 109 Suppl 2:S493–514
Nicodemus KK, Folsom AR (2001) Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 24:1192–1197
Forsen L, Meyer HE, Midthjell K, Edna TH (1999) Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag Health Survey. Diabetologia 42:920–925
Miao J, Brismar K, Nyren O, Ugarph-Morawski A, Ye W (2005) Elevated hip fracture risk in type 1 diabetic patients: a population-based cohort study in Sweden. Diabetes Care 28:2850–2855
Janghorbani M, Feskanich D, Willett WC, Hu F (2006) Prospective study of diabetes and risk of hip fracture: the Nurses’ Health Study. Diabetes Care 29:1573–1578
Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505
Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporos Int 18:427–444
Lipscombe LL, Jamal SA, Booth GL, Hawker GA (2007) The risk of hip fractures in older individuals with diabetes: a population-based study. Diabetes Care 30:835–841
Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T (2009) Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res 24:702–709
Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ, Jamal SA, Black DM, Cummings SR (2001) Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 86:32–38
de Liefde II, van der Klift M, de Laet CE, van Daele PL, Hofman A, Pols HA (2005) Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos Int 16:1713–1720
Melton LJI (1997) Epidemiology of spinal osteoporosis. Spine 22:2S–11S
Cooper C, O’Neill T, Silman A (1993) The epidemiology of vertebral fractures. Bone 14:89–97
Jalava T, Sarna S, Pylkkanen L, Mawer B, Kanis JA, Selby P, Davies M, Adams J, Francis RM, Robinson J, McCloskey E (2003) Association between vertebral fracture and increased mortality in osteoporotic patients. J Bone Miner Res 18:1254–1260
Kado DM, Browner WS, Palermo L, Nevitt MC, Genant HK, Cummings SR (1999) Vertebral fractures and mortality in older women: a prospective study. Study of Osteoporotic Fractures Research Group. Arch Intern Med 159:1215–1220
Kado DM, Duong T, Stone KL, Ensrud KE, Nevitt MC, Greendale GA, Cummings SR (2003) Incident vertebral fractures and mortality in older women: a prospective study. Osteoporos Int 14:589–594
Harma M, Heliovaara M, Aromaa A, Knekt P (1986) Thoracic spine compression fractures in Finland. Clin Orthop Relat Res 205:188–194
Melton LJ 3rd, Atkinson EJ, O’Fallon WM, Wahner HW, Riggs BL (1993) Long-term fracture prediction by bone mineral assessed at different skeletal sites. J Bone Miner Res 8:1227–1233
Shin CS, Kim MJ, Shim SM, Kim JT, Yu SH, Koo BK, Cho HY, Choi HJ, Cho SW, Kim SW, Kim SY, Yang SO, Cho NH (2012) The prevalence and risk factors of vertebral fractures in Korea. J Bone Miner Metab 30:183−192
Kiel D (1995) Assessing vertebral fractures. National Osteoporosis Foundation Working Group on Vertebral Fractures. J Bone Miner Res 10:518–523
Genant HK, Wu CY, van Kuijk C, Nevitt MC (1993) Vertebral fracture assessment using a semiquantitative technique. J Bone Miner Res 8:1137–1148
Carbone L, Buzkova P, Fink HA, Lee JS, Chen Z, Ahmed A, Parashar S, Robbins JR (2010) Hip fractures and heart failure: findings from the Cardiovascular Health Study. Eur Heart J 31:77–84
Sennerby U, Melhus H, Gedeborg R, Byberg L, Garmo H, Ahlbom A, Pedersen NL, Michaelsson K (2009) Cardiovascular diseases and risk of hip fracture. JAMA 302:1666–1673
Leslie WD, Lix LM, Prior HJ, Derksen S, Metge C, O’Neil J (2007) Biphasic fracture risk in diabetes: a population-based study. Bone 40:1595–1601
Giangregorio LM, Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E, Kanis JA (2012) FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res 27:301–308
Viegas M, Costa C, Lopes A, Griz L, Medeiro MA, Bandeira F (2011) Prevalence of osteoporosis and vertebral fractures in postmenopausal women with type 2 diabetes mellitus and their relationship with duration of the disease and chronic complications. J Diabetes Complications 25:216–221
Greco EA, Fornari R, Rossi F, Santiemma V, Prossomariti G, Annoscia C, Aversa A, Brama M, Marini M, Donini LM, Spera G, Lenzi A, Lubrano C, Migliaccio S (2010) Is obesity protective for osteoporosis? Evaluation of bone mineral density in individuals with high body mass index. Int J Clin Pract 64:817–820
Kim KC, Shin DH, Lee SY, Im JA, Lee DC (2010) Relation between obesity and bone mineral density and vertebral fractures in Korean postmenopausal women. Yonsei Med J 51:857–863
Acknowledgments
We thank all the participants and research staff involved in this multicenter study. We also acknowledge the data management support of C&R Research in the preparation of this manuscript. Editorial assistance was provided by Dr. Sujata Shah of the Asia–Pacific Medical Writing Team (AMRIT) of Sanofi-Aventis. This work was supported by Sanofi-Aventis Korea. Participating investigators include Chan Soo Shin of Seoul National University College of Medicine, In-Kyu Lee of the Kyungpook National University School of Medicine, Yoon-Sok Chung of the Ajou University School of Medicine, Hong Sun Baek of the Chonbuk National University Hospital, Dong-Jin Chung of the Chonnam National University College of Medicine, Moon-Gi Choi of the Hallym University Sacred Heart Hospital, Minho Shong of the Chungnam National University School of Medicine, Ho-Sang Shon of the Catholic University of Daegu School of Medicine, Mi-Kyung Park of the Dong-A University Medical Center, Kyung Wan Min of the Eulji University Hospital, Kang-Seo Park of the Eulji University School of Medicine, Jin-Yub Kim of the Gangneung Asan Hospital, Jae Myung Yoo of the Hallym University Kangnam Sacred Heart Hospital, Jeong Hyun Park of the Inje University College of Medicine, Hyoung-Keun Oh of the Inje University Ilsan Paik Hospital, Hye Soon Kim of the Keimyung University School of Medicine, Suk Chon of the KyungHee University School of Medicine, Mi Kyung Kim of the Maryknoll Medical Center, Young Duk Song of the National Health Insurance Corporation Ilsan Hospital, Sung-Kil Lim of the Yonsei University College of Medicinel, Ji Oh Mok of the Soonchunhyang University Bucheon Hospital, Soon Jib Yoo of the Catholic University of Korea School of Medicine, Bong-Yun Cha of the Catholic University of Korea School of Medicine Seoul St. Mary’s Hospital,and Young-IL Kim of the Ulsan University Hospital.
Conflict of interest
All authors have no conflicts of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
D. J. Chung and H. J. Choi contributed equally to this work.
About this article
Cite this article
Chung, D.J., Choi, H.J., Chung, YS. et al. The prevalence and risk factors of vertebral fractures in Korean patients with type 2 diabetes. J Bone Miner Metab 31, 161–168 (2013). https://doi.org/10.1007/s00774-012-0398-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00774-012-0398-5