Ankle fractures do not predict osteoporotic fractures in women with or without diabetes
- 242 Downloads
It is not clear whether ankle fractures predict future osteoporotic fractures in women, and whether diabetes influences this relationship. We found that a prior ankle fracture does not predict subsequent osteoporotic fractures in women with or without diabetes.
We aimed to determine: (1) whether a prior ankle fracture was a risk factor for a subsequent major osteoporotic fracture in older women; (2) whether this risk was modified by the presence of diabetes; (3) the risk factors for ankle fracture in older women.
We identified 3,054 women age 50 years and older with diabetes and 9,151 matched controls using the Manitoba Bone Density Program database. Multivariable regression models were used to examine factors associated with prior ankle fracture, and the importance of prior ankle fracture as a predictor of subsequent major osteoporotic fracture during a mean 4.8 years of observation.
A prior ankle fracture was not a significant predictor of subsequent major osteoporotic fracture for women with diabetes (hazard ratio [HR] 1.13; 95% confidence interval [CI], 0.68–1.83; p = 0.623) or women without diabetes (HR 1.16; 95% CI, 0.79–1.71; p = 0.460), and there was no interaction between diabetes and ankle fracture after pooling all women in the cohort (p = 0.971). The presence of diabetes was not independently associated with prior ankle fracture (adjusted odds ratio [OR] 1.14 [95% CI, 0.93–1.38], p = 0.200), whereas higher body mass index (adjusted OR 1.04 per standard deviation increase [95% CI, 1.03–1.06], p < 0.001), previous major osteoporotic fracture (adjusted OR 1.40 [95% CI, 1.13–1.75], p = 0.002), and multiple comorbidities (>6 ambulatory diagnostic groups) (adjusted OR 1.81 [95% CI, 1.40–2.36], p < 0.001) were related to prior ankle fracture.
Ankle fracture was not a significant predictor of major osteoporotic fracture in women, and a diagnosis of diabetes did not influence the relationship.
KeywordsAnkle fracture Diabetes Osteoporosis Osteoporotic fracture Risk factor
We are indebted to Manitoba Health for providing data (HIPC File No. 2008/2009–08). The results and conclusions are those of the authors, and no official endorsement by Manitoba Health is intended or should be inferred. This article has been reviewed and approved by the members of the Manitoba Bone Density Program Committee.
Conflicts of interest
W.D. Leslie has served on the advisory board for Amgen, Genzyme and Novartis; has received unrestricted research grants from Amgen, Genzyme, Merck Frosst, Proctor & Gamble and Sanofi-Aventis; has received speaker fees from Amgen and Merck Frosst; has received travel funds from Genzyme.
J.D. Adachi has served as a consultant and speaker for Amgen, Astra Zeneca, Bristol-Myers Squibb, Eli Lilly, GSK, Merck Frosst, Novartis, Nycomed, Pfizer, Procter & Gamble, Roche, Sanofi Aventis, Servier and Wyeth; has received clinical trials grants from Amgen, Bristol-Myers Squibb, Eli Lilly, GSK, Merck Frosst; Novartis, Pfizer, Procter & Gamble, Sanofi Aventis, Roche and Wyeth.
A. Papaioannou has served on the advisory board for Amgen, Eli Lilly, Merck Frosst, Proctor & Gamble and Novartis; has consulted for Amgen, Aventis Pharma, Eli Lilly, Lundbeck Canada Inc., Merck Frosst, Novartis, Proctor & Gamble, Servier, Warner Chillcott and Wyeth-Ayerst; has received unrestricted research grants from Amgen, Eli Lilly, Merck Frosst, Proctor & Gamble and Sanofi-Aventis; has received clinical trial grants from Novartis and Phizer, has received a research grant from the Ontario Ministry of Health and Long-Term Care; has served as a member of the Continuing Medical Education Steering Committee of the Ontario College of Family Physicians.
J.M. Pritchard, L.M. Giangregorio and G. Ioannidis have no conflict of interest to declare.
- 3.Kanis JA, Johnell O, De Laet C, Johansson H, Oden A, Delmas P, Eisman J, Fujiwara S, Garnero P, Kroger H, McCloskey EV, Mellstrom D, Melton LJ, Pols H, Reeve J, Silman A, Tenenhouse A (2004) A meta-analysis of previous fracture and sub-sequent fracture risk. Bone 35:375–382PubMedCrossRefGoogle Scholar
- 5.Papaioannou A, Kennedy C, Ioannidis G, Sawka A, Hopman WM, Pickard L, Brown JP, Josse RG, Kaiser S, Anastassiades T, Goltzman D, Papadimitropoulous M, Tenenhouse A, Prior JC, Olszynski WP, Adachi JD, for the CaMos Study Group (2009) The impact of incident fractures on health-related quality of life: 5 years of data from the Canadian Multicentre Osteoporosis Study. Osteoporos Int 20:703–714PubMedCrossRefGoogle Scholar
- 11.Hasselman CT, Vogt MT, Stone KL, Cauley JA, Conti SF (2003) Foot and ankle fractures in elderly white women. Incidence and risk factors. J Bone Jt Surg Am 85-A(5):820–824Google Scholar
- 19.Blanchard JF, Ludwig S, Wajda A, Dean H, Anderson K, Kendall O (1996) Incidence and prevalence of diabetes in Manitoba. 1986–1991. Diabetes Care 27:1047–1053Google Scholar
- 24.Leslie WDBC, Langsetmo L, Adachi JD, Hanley DA, Ioannidis G, Goltzman D, Papaioannou A, Josse R, Kovacs CS, Olszynski WP, Towheed T, Kaiser SM, Prior J, Jamal S, Kreiger N, Brown JP, the CaMos Research Group (2011) Construction and validation of a simplified fracture risk assessment tool for Canadian women and men: Results from the CaMos and Manitoba BMD cohorts. Osteoporos Int (in press)Google Scholar
- 25.Watts NB, Lewiecki EM, Miller PD, Baim S (2008) National Osteoporosis Foundation 2008 Clinician’s Guide to Prevention and Treatment of Osteoporosis and the World Health Organization Fracture Risk Assessment Tool (FRAX): What they mean to the bone densitometrist and bone technologist. J Clin Densitom 11(4):473–477PubMedCrossRefGoogle Scholar
- 26.Sharma S, Fraser M, Lovell F, Reece A, McLellan AR (2008) Characteristics of males over 50 years who present with a fracture. J Bone Jt Surg (Br) 90B(1):72–77Google Scholar
- 27.Langsetmo L, Hanley DA, Kreiger N, Jamal SA, Prior J, Adachi JD, Davison KS, Kovacs C, Anastassiades T, Tenenhouse A, Goltzman D (2008) Geographic variation of bone mineral density and selected risk factors for prediction of incident fracture among Canadians 50 and older. Bone 43(4):672–678PubMedCrossRefGoogle Scholar
- 39.Schwartz AV, Sellmeyer DE, Vittinghoff E, Palermo L, Lecka-Czernik B, Feingold KR, Strotmeyer ES, Resnick HE, Carbone L, Beamer BA, Park SW, Lane NE, Harris TB, Cummings SR (2006) Thiazolidinedione use and bone loss in older diabetic adults. J Clin Endocrinol Metab 91(9):3349–3354PubMedCrossRefGoogle Scholar