Osteoporosis International

, Volume 17, Issue 4, pp 495–500 | Cite as

Diabetes mellitus and the risk of non-vertebral fractures: the Tromsø study

  • Luai A. Ahmed
  • Ragnar M. Joakimsen
  • Gro K. Berntsen
  • Vinjar Fønnebø
  • Henrik Schirmer
Original Article


We wanted to determine the risk of non-vertebral fracture associated with type and duration of diabetes mellitus, adjusting for other known risk factors. This is a population-based 6-year follow-up of 27,159 subjects from the municipality of Tromsø, followed from 1994 until 2001. The age range was 25–98 years. Self-reported diabetes cases were validated by review of the medical records. All non-vertebral fractures were registered by computerized search in radiographic archives. A total of 1,249 non-vertebral fractures was registered, and 455 validated cases of diabetes were identified. Men with type I diabetes had an increased risk of all non-vertebral [relative risk (RR) 3.1 (95% CI 1.3–7.4)] and hip fractures [RR 17.8 (95% CI 5.6–56.8)]. Diabetic women, regardless of type of diabetes, had significantly increased hip fracture risk [RR 8.9 (95% CI 1.2–64.4) and RR 2.0 (95% CI 1.2–3.6)] for type I and type II diabetes, respectively. Diabetic men and women using insulin had increased hip fracture risk. Duration of disease did not alter hip fracture risk. An increased risk of all non-vertebral fractures and, especially, hip fractures was associated with diabetes mellitus, especially type I. Type II diabetes was associated with increased hip fracture risk in women only.


Diabetes mellitus Hip fracture Insulin Non-vertebral fractures Type I diabetes Type II diabetes 


  1. 1.
    Sue A, Brown JLS (2004) Osteoporosis: an under-appreciated complication of diabetes. Clin Diabetes 22:10–20CrossRefGoogle Scholar
  2. 2.
    Forsen L, et al (1999) Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag health survey. Diabetologia 42:920–925PubMedCrossRefGoogle Scholar
  3. 3.
    Schwartz AV, et al (2001) Older women with diabetes have an increased risk of fracture: a prospective study.[see comment]. Journal of Clinical Endocrinology & Metabolism 86(1):32–38PubMedCrossRefGoogle Scholar
  4. 4.
    Ottenbacher KJ, et al (2002) Diabetes mellitus as a risk factor for hip fracture in Mexican American older adults. J Gerontol A Biol Sci Med Sci 57(10):M648–M653PubMedGoogle Scholar
  5. 5.
    Ivers RQ, et al (2001) Diabetes and risk of fracture: the Blue Mountains eye study. Diabetes Care 24(7):1198–1203PubMedCrossRefGoogle Scholar
  6. 6.
    de Liefde II, v.d. KM, de Laet CEDH, van Daele PLA, Hofman A Pols HAP (2005) Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam study. Osteoporos Int, published online 7 June 2005Google Scholar
  7. 7.
    Seeley DG, et al (1996) Predictors of ankle and foot fractures in older women. J Bone Miner Res 11(9):1347–1355PubMedCrossRefGoogle Scholar
  8. 8.
    Cummings SR, et al (1995) Risk factors for hip fracture in white women. N Engl J Med 332:767–773PubMedCrossRefGoogle Scholar
  9. 9.
    Joakimsen RM, et al (2001) The Tromso study: registration of fractures, how good are self-reports, a computerized radiographic register and a discharge register? Osteoporos Int 12(12):1001–1005PubMedCrossRefGoogle Scholar
  10. 10.
    SAS Institute (1992) SAS/STAT guide for personal computers, version 6. Cary, NC (USA)Google Scholar
  11. 11.
    Joakimsen RM (1999) Risk factors for non-vertebral fractures in a middle-aged population (thesis). Institute of Community Medicine, University of Tromsø, TromsøGoogle Scholar
  12. 12.
    Stene LC, et al (2004) [Prevalence of diabetes mellitus in Norway] Hvor mange har diabetes mellitus i Norge? Tidsskr Nor Laegeforen 124(11):1511–1514PubMedGoogle Scholar
  13. 13.
    Meyer HE, Tverdal A, Falch JA (1993) Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 137:1203–1211PubMedGoogle Scholar
  14. 14.
    Kelsey JL, et al (1992) Risk factors for fractures of the distal forearm and proximal humerus. The Study of Osteoporotic Fractures Research Group (erratum appears in Am J Epidemiol 135:1183). Am J Epidemiol 135:477–489PubMedGoogle Scholar
  15. 15.
    Meyer HE, et al (1995) Risk factors for hip fracture in a high incidence area: a case–control study from Oslo, Norway. Osteoporos Int 5:239–246PubMedCrossRefGoogle Scholar
  16. 16.
    Melchior TM, Sorensen H, Torp-Pedersen C (1994) Hip and distal arm fracture rates in peri- and postmenopausal insulin-treated diabetic females. J Intern Med 236(2):203–238PubMedCrossRefGoogle Scholar
  17. 17.
    Krakauer JC, et al (1995) Bone loss and bone turnover in diabetes. Diabetes 44:775–782PubMedCrossRefGoogle Scholar
  18. 18.
    Nicodemus KK, Folsom AR, S. Iowa Women’s Health (2001) Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 24(7):1192–1197PubMedCrossRefGoogle Scholar
  19. 19.
    Schwartz AV, Sellmeyer DE (2004) Women, type 2 diabetes, and fracture risk. Curr Diab Rep 4(5):364–369PubMedCrossRefGoogle Scholar
  20. 20.
    Hanley DA, et al (2003) Associations among disease conditions, bone mineral density, and prevalent vertebral deformities in men and women 50 years of age and older: cross-sectional results from the Canadian Multicenter Osteoporosis Study. J Bone Mine Res 18(4):784–790CrossRefGoogle Scholar
  21. 21.
    van Daele PL, et al (1995) Bone density in non-insulin-dependent diabetes mellitus. The Rotterdam study (comment). Ann Intern Med 122(6):409–414PubMedGoogle Scholar
  22. 22.
    Hadjidakis DJ, MES, Raptis AE, Raptis SA (2005) Diabetes and premature menopause: is their co-existence detrimental to the skeleton? Eur J Endocrinol 152:437–442PubMedCrossRefGoogle Scholar
  23. 23.
    Schwartz AV, et al (2002) Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care 25(10):1749–1754PubMedCrossRefGoogle Scholar
  24. 24.
    Wallace C, et al (2002) Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer. Diabetes Care 25(11):1983–1986PubMedCrossRefGoogle Scholar
  25. 25.
    Balint E, et al (2001) Glucose-induced inhibition of in vitro bone mineralization. Bone 28(1):21–28PubMedCrossRefGoogle Scholar
  26. 26.
    Isomaa B (2003) A major health hazard: the metabolic syndrome. Life Sci 73(19):2395–2411PubMedCrossRefGoogle Scholar

Copyright information

© International Osteoporosis Foundation and National Osteoporosis Foundation 2005

Authors and Affiliations

  • Luai A. Ahmed
    • 1
  • Ragnar M. Joakimsen
    • 2
  • Gro K. Berntsen
    • 1
  • Vinjar Fønnebø
    • 1
  • Henrik Schirmer
    • 1
    • 3
  1. 1.Institute of Community MedicineUniversity of TromsøTromsøNorway
  2. 2.Department of Internal MedicineUniversity Hospital of TromsøTromsøNorway
  3. 3.Department of CardiologyUniversity Hospital of TromsøTromsøNorway

Personalised recommendations