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Diabetologia

, Volume 57, Issue 10, pp 2057–2065 | Cite as

Fracture risk in diabetic elderly men: the MrOS study

  • Nicola NapoliEmail author
  • Elsa S. Strotmeyer
  • Kristine E. Ensrud
  • Deborah E. Sellmeyer
  • Douglas C. Bauer
  • Andrew R. Hoffman
  • Thuy-Tien L. Dam
  • Elizabeth Barrett-Connor
  • Lisa Palermo
  • Eric S. Orwoll
  • Steven R. Cummings
  • Dennis M. Black
  • Ann V. Schwartz
Article

Abstract

Aims/hypothesis

Diabetes mellitus is associated with increased fracture risk in women but few studies are available in men. To evaluate the relationship between diabetes and prospective non-vertebral fractures in elderly men, we used data from the Osteoporotic Fractures in Men (MrOS) study.

Methods

The MrOS enrolled 5,994 men (aged ≥65 years). Diabetes (ascertained by self-report, the use of medication for diabetes or an elevated fasting glucose level) was reported in 881 individuals, 80 of whom were using insulin. Hip and spine bone mineral density (BMD) was measured using dual x-ray absorptiometry (DXA). After recruitment, the men were followed for incident non-vertebral fractures using a triannual (3 yearly) questionnaire for an average of 9.1 (SD 2.7) years. The Cox proportional hazards model was used to assess the incident risk of fractures.

Results

In models adjusted for age, race, clinic site and total hip BMD, the risk of non-vertebral fracture was higher in men with diabetes compared with normoglycaemic men (HR 1.30, 95% CI 1.09, 1.54) and was elevated in men using insulin (HR 2.46, 95% CI 1.69, 3.59). Men with impaired fasting glucose did not have a higher risk of fracture compared with normoglycaemic men (HR 1.04, 95% CI 0.89, 1.21). After multivariable adjustment, the risk of non-vertebral fracture remained higher only among men with diabetes who were using insulin (HR 1.74, 95% CI 1.13, 2.69).

Conclusions/interpretation

Men with diabetes who are using insulin have an increased risk of non-vertebral fracture for a given age and BMD.

Keywords

Bone Diabetes Fractures Impaired fasting glucose Insulin Osteoporosis 

Abbreviations

BMD

Bone mineral density

CKD-EPI

Chronic Kidney Disease Epidemiology Collaboration

DXA

Dual energy x-ray absorptiometry

IFG

Impaired fasting glucose

MrOS

Osteoporotic Fractures in Men

PASE

Physical Activity Scale for the Elderly

TZDs

Thiazolidinediones

Notes

Acknowledgements

The authors wish to thank C. C. Dant of Medcom Consulting for his expert assistance preparing this manuscript. The authors represent the Osteoporotic Fractures in Men (MrOS) research group.

Funding

The Osteoporotic Fractures in Men (MrOS) study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), the National Center for Research Resources (NCRR) and NIH Roadmap for Medical Research under the following grant numbers: U01 AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01AG18197, U01-AG027810, and UL1 RR024140. Glucose measurements were supported by a grant from the American ADA (1-04-JF-46, Strotmeyer ES).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

NN was involved in the concept, in data interpretation and in writing the manuscript. KEE and ESS were involved in the concept and design of the study, the acquisition and interpretation of data and the critical review of the paper for important intellectual content. ARH, DES, TLD, EB-C, DCB, DMB, ESO and SRC took part in the acquisition and interpretation of the data and in revising the article for important intellectual content. LP was involved in data acquisition and analysis and in revising the article. AVS is the guarantor of the study and made substantial contributions to the conception and design of the study, to the analysis and interpretation of the data, and to revising the article critically for important intellectual content. All authors gave their approval of the final manuscript.

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Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Nicola Napoli
    • 1
    • 2
    Email author
  • Elsa S. Strotmeyer
    • 3
  • Kristine E. Ensrud
    • 4
    • 5
  • Deborah E. Sellmeyer
    • 6
  • Douglas C. Bauer
    • 7
  • Andrew R. Hoffman
    • 8
  • Thuy-Tien L. Dam
    • 9
  • Elizabeth Barrett-Connor
    • 9
  • Lisa Palermo
    • 7
  • Eric S. Orwoll
    • 10
  • Steven R. Cummings
    • 11
  • Dennis M. Black
    • 7
  • Ann V. Schwartz
    • 7
  1. 1.Division of Endocrinology and DiabetesUniversità Campus Bio-Medico di RomaRomeItaly
  2. 2.Division of Bone and Mineral DiseasesWashington UniversitySt LouisUSA
  3. 3.Department of Epidemiology, Graduate School of Public HealthUniversity of PittsburghPittsburghUSA
  4. 4.Department of Medicine and Division of Epidemiology & Community HealthUniversity of MinnesotaMinneapolisUSA
  5. 5.Center for Chronic Disease Outcomes Research VA Health Care SystemMinneapolisUSA
  6. 6.School of MedicineJohns Hopkins UniversityBaltimoreUSA
  7. 7.University of California, San FranciscoSan FranciscoUSA
  8. 8.VA Palo Alto Health Care SystemPalo AltoUSA
  9. 9.University of California, San DiegoLa JollaUSA
  10. 10.Oregon Health & Science UniversityPortlandUSA
  11. 11.California Pacific Medical CenterSan FranciscoUSA

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