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Incidence of fractures in patients with type 1 diabetes mellitus—a retrospective study with 4420 patients

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Abstract

Summary

This retrospective study investigated the incidence of fracture in 4420 type 1 diabetes (T1DM) patients. Our findings indicate that patients with T1DM have an increased incidence of fractures. Further studies and preventive measures are urgently needed.

Introduction

The aim of this study was to investigate the incidence of fracture in patients with type 1 diabetes mellitus (T1DM).

Methods

This study is based on the German Disease Analyzer database and included 4258 adult individuals with a T1DM diagnosis documented between January 2000 and December 2015 in 1203 general practices in Germany. Individual matching of T1DM and non-diabetic patients was performed. The cumulative incidence of new fractures was shown for up to 10 years after the index date using Kaplan-Meier curves. Cox proportional hazard models (dependent variable: incident fracture) were used to estimate the effect of T1DM on fracture incidence, as well as the effect of predefined variables on fracture incidence.

Results

After 10 years of follow-up, the cumulative fracture incidence was 18.4% for T1DM patients and 9.9% for non-diabetic patients (p < 0.001). A strong association between T1DM and fractures was found (HR, 2.01 (95% CI, 1.70–2.38) p < 0.001) in both female and male patients. Significant differences between T1DM and non-diabetes patients were found in lower leg/ankle, foot and toe, shoulder/upper arm, and rib(s), sternum and thoracic spine fractures. A significant association between higher age and fracture incidence was observed in T1DM patients.

Conclusions

In summary, we found that patients with T1DM have a twofold increased fracture rate compared with healthy controls. Furthermore, fractures were associated with increased age and high HbA1c values.

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References

  1. Xu G, Liu B, Sun Y, Du Y, Snetselaar LG, Hu FB, Bao W (2018) Prevalence of diagnosed type 1 and type 2 diabetes among US adults in 2016 and 2017: population based study. BMJ 362:k1497

    Article  Google Scholar 

  2. Bass E, French DD, Bradham DD, Rubenstein LZ (2007) Risk-adjusted mortality rates of elderly veterans with hip fractures. Ann Epidemiol 17:514–519

    Article  Google Scholar 

  3. Hothersall EJ, Livingstone SJ, Looker HC et al (2014) Contemporary risk of hip fracture in type 1 and type 2 diabetes: a national registry study from Scotland. J Bone Miner Res 29:1054–1060

    Article  Google Scholar 

  4. Nicodemus KK, Folsom AR (2001) Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 24:1192–1197

    Article  CAS  Google Scholar 

  5. 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

    Article  CAS  Google Scholar 

  6. Vestergaard P, Rejnmark L, Mosekilde L (2005) Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk. Diabetologia 48:1292–1299

    Article  CAS  Google Scholar 

  7. Starup-Linde J, Frost M, Vestergaard P, Abrahamsen B (2017) Epidemiology of fractures in diabetes. Calcif Tissue Int 100:109–121

    Article  CAS  Google Scholar 

  8. Jensen MH, Vestergaard P (2019) Hypoglycaemia and type 1 diabetes are associated with an increased risk of fractures. Osteoporos Int

  9. Shah VN, Shah CS, Snell-Bergeon JK (2015) Type 1 diabetes and risk of fracture: meta-analysis and review of the literature. Diabet Med 32:1134–1142

    Article  CAS  Google Scholar 

  10. Shah VN, Harrall KK, Shah CS, Gallo TL, Joshee P, Snell-Bergeon JK, Kohrt WM (2017) Bone mineral density at femoral neck and lumbar spine in adults with type 1 diabetes: a meta-analysis and review of the literature. Osteoporos Int 28:2601–2610

    Article  CAS  Google Scholar 

  11. Starup-Linde J, Vestergaard P (2015) Management of endocrine disease: diabetes and osteoporosis: cause for concern? Eur J Endocrinol 173:R93–R99

    Article  CAS  Google Scholar 

  12. Seeman E (2008) Bone quality: the material and structural basis of bone strength. J Bone Miner Metab 26:1–8

    Article  Google Scholar 

  13. Seeman E, Delmas PD (2006) Bone quality--the material and structural basis of bone strength and fragility. N Engl J Med 354:2250–2261

    Article  CAS  Google Scholar 

  14. Rakic V, Davis WA, Chubb SA, Islam FM, Prince RL, Davis TM (2006) Bone mineral density and its determinants in diabetes: the Fremantle diabetes study. Diabetologia 49:863–871

    Article  CAS  Google Scholar 

  15. Pfeil A, Lehmann G, Lange U (2018) Update DVO guidelines 2017 on “prophylaxis, diagnostics and treatment of osteoporosis in postmenopausal women and men”: what is new, what remains for rheumatologists? Z Rheumatol 77:759–763

    Article  CAS  Google Scholar 

  16. Neuerburg C, Schmidmaier R, Schilling S, Kammerlander C, Bocker W, Mutschler W, Stumpf U (2015) Identification, diagnostics and guideline conform therapy of osteoporosis (DVO) in trauma patients : a treatment algorithm. Unfallchirurg 118:913–924

    Article  CAS  Google Scholar 

  17. Kanis JA, Cooper C, Rizzoli R, Reginster JY (2019) European guidance for the diagnosis and management of osteoporosis in postmenopausal women. Osteoporos Int 30:3–44

    Article  CAS  Google Scholar 

  18. Rathmann W, Bongaerts B, Carius HJ, Kruppert S, Kostev K (2018) Basic characteristics and representativeness of the German disease analyzer database. Int J Clin Pharmacol Ther 56:459–466

    Article  Google Scholar 

  19. Rathmann W, Kostev K (2015) Fracture risk in patients with newly diagnosed type 2 diabetes: a retrospective database analysis in primary care. J Diabetes Complicat 29:766–770

    Article  Google Scholar 

  20. Pscherer S, Kostev K, Dippel FW, Rathmann W (2016) Fracture risk in patients with type 2 diabetes under different antidiabetic treatment regimens: a retrospective database analysis in primary care. Diabetes Metab Syndr Obes 9:17–23

    CAS  PubMed  PubMed Central  Google Scholar 

  21. Dombrowski S, Kostev K, Jacob L (2017) Use of dipeptidyl peptidase-4 inhibitors and risk of bone fracture in patients with type 2 diabetes in Germany-a retrospective analysis of real-world data. Osteoporos Int 28:2421–2428

    Article  CAS  Google Scholar 

  22. 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

    Article  Google Scholar 

  23. Weber DR, Haynes K, Leonard MB, Willi SM, Denburg MR (2015) Type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN). Diabetes Care 38:1913–1920

    Article  Google Scholar 

  24. Venkatesan M, Fong A, Sell PJ (2012) CT scanning reduces the risk of missing a fracture of the thoracolumbar spine. J Bone Joint Surg Br Vol 94:1097–1100

    Article  CAS  Google Scholar 

  25. Brito LM, Chein MB, Marinho SC, Duarte TB (2011) Epidemiological evaluation of victims of spinal cord injury. Rev Col Bras Cir 38:304–309

    Article  Google Scholar 

  26. Russo A, Reginelli A, Zappia M, Rossi C, Fabozzi G, Cerrato M, Macarini L, Coppolino F (2013) Ankle fracture: radiographic approach according to the Lauge-Hansen classification. Musculoskelet Surg 97(Suppl 2):S155–S160

    Article  Google Scholar 

  27. Clare MP (2008) A rational approach to ankle fractures. Foot Ankle Clin 13:593–610

    Article  Google Scholar 

  28. Arimoto HK, Forrester DM (1980) Classification of ankle fractures: an algorithm. AJR Am J Roentgenol 135:1057–1063

    Article  CAS  Google Scholar 

  29. Hamilton EJ, Rakic V, Davis WA, Chubb SA, Kamber N, Prince RL, Davis TM (2009) Prevalence and predictors of osteopenia and osteoporosis in adults with type 1 diabetes. Diabet Med 26:45–52

    Article  CAS  Google Scholar 

  30. Napoli N, Schwartz AV, Schafer AL et al (2018) Vertebral fracture risk in diabetic elderly men: the MrOS study. J Bone Miner Res 33:63–69

    Article  Google Scholar 

  31. Kroger H, Tuppurainen M, Honkanen R, Alhava E, Saarikoski S (1994) Bone mineral density and risk factors for osteoporosis–a populationbased study of 1600 perimenopausal women. Calcif Tissue Int 55:1–7

    Article  CAS  Google Scholar 

  32. Alswat KA (2017 May) Gender disparities in osteoporosis. J Clin Med Res 9(5):382–387

    Article  Google Scholar 

  33. Vavanikunnel J, Charlier S, Becker C, Schneider C, Jick SS, Meier CR, Meier C (2019) Association between glycemic control and risk of fracture in diabetic patients: a nested case-control study. J Clin Endocrinol Metab 104(5):1645–1654

    Article  Google Scholar 

  34. Leanza G, Maddaloni E, Pitocco D, Conte C, Palermo A, Maurizi AR, Pantano AL, Suraci C, Altomare M, Strollo R, Manfrini S, Pozzilli P, Schwartz AV, Napoli N (2019) Risk factors for fragility fractures in type 1 diabetes. Bone 125:194–199

    Article  CAS  Google Scholar 

  35. Ferrari SL, Abrahamsen B, Napoli N, Akesson K, Chandran M, Eastell R, el-Hajj Fuleihan G, Josse R, Kendler DL, Kraenzlin M, Suzuki A, Pierroz DD, Schwartz AV, Leslie WD, Bone and Diabetes Working Group of IOF (2018) Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int 29(12):2585–2596

    Article  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of General, Trauma, and Reconstructive Surgery, Munich University Hospital LMU, Munich, Germany

    U. Stumpf & W. Böcker

  2. Frankfurt Center of Bone Health and Philips-University of Marburg, Marburg, Germany

    P. Hadji

  3. Clementine Children’s Hospital, Division of Pediatric Diabetes, Frankfurt, Germany

    L. van den Boom

  4. Epidemiology, IQVIA, Main Airport Center, Unterschweinstiege 2-14, 60549, Frankfurt am Main, Germany

    K. Kostev

Authors
  1. U. Stumpf
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  2. P. Hadji
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  3. L. van den Boom
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  4. W. Böcker
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  5. K. Kostev
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Correspondence to K. Kostev.

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Stumpf, U., Hadji, P., van den Boom, L. et al. Incidence of fractures in patients with type 1 diabetes mellitus—a retrospective study with 4420 patients. Osteoporos Int 31, 1315–1322 (2020). https://doi.org/10.1007/s00198-020-05344-w

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  • DOI: https://doi.org/10.1007/s00198-020-05344-w

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