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Excess of all-cause mortality after a fracture in type 2 diabetic patients: a population-based cohort study

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Abstract

Summary

Post-fracture mortality in type 2 diabetes mellitus (T2DM) patients has been poorly studied. We report an absolute and relative excess all-cause mortality following a fracture in these patients compared to non-diabetic patients.

Introduction

T2DM and osteoporotic fractures are independently associated with a reduced lifespan, but it is unknown if T2DM confers an excess post-fracture mortality compared to non-diabetic fracture patients. We report post-fracture all-cause mortality according to T2DM status.

Methods

This is a population-based cohort study using data from the SIDIAP database. All ≥50 years old T2DM patients registered in SIDIAP in 2006–2013 and two diabetes-free controls matched on age, gender, and primary care center were selected. Study outcome was all-cause mortality following incident fractures. Participants were followed from date of any fracture (AF), hip fracture (HF), and clinical vertebral fracture (VF) until the earliest of death or censoring. Cox regression was used to calculate mortality according to T2DM status after adjustment for age, gender, body mass index, smoking, alcohol intake, and previous ischemic heart and cerebrovascular disease.

Results

We identified 166,106 T2DM patients and 332,212 non-diabetic, of which 11,066 and 21,564, respectively, sustained a fracture and were then included. Post-fracture mortality rates (1000 person-years) were (in T2DM vs non-diabetics) 62.7 vs 49.5 after AF, 130.7 vs 112.7 after HF, and 54.9 vs 46.2 after VF. Adjusted HR (95% CI) for post-AF, post-HF, and post-VF mortality was 1.30 (1.23–1.37), 1.28 (1.20–1.38), and 1.20 (1.06–1.35), respectively, for T2DM compared to non-diabetics.

Conclusions

T2DM patients have a 30% increased post-fracture mortality compared to non-diabetics and a remarkable excess in absolute mortality risk. More research is needed on the causes underlying such excess risk, and on the effectiveness of measures to reduce post-fracture morbi-mortality in T2DM subjects.

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Authors and Affiliations

  1. GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, CIBERFES ISCIII, Universitat Autonoma de Barcelona, Barcelona, Spain

    D. Martinez-Laguna, C. Reyes, C. Carbonell-Abella & D. Prieto-Alhambra

  2. Ambit Barcelona, Primary Care Department, Institut Catala de la Salut, Barcelona, Spain

    D. Martinez-Laguna & C. Carbonell-Abella

  3. Internal Medicine Department IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain

    X. Nogues, A. Diez-Perez & D. Prieto-Alhambra

  4. Department of Medicine, Holbæk Hospital, Holbæk, Denmark

    B. Abrahamsen

  5. OPEN Odense Patient Data Explorative Network, Institute of Clinical Research, Department of Clinical Research, University of Southern Denmark, Odense, Denmark

    B. Abrahamsen

  6. Autonomous University of Barcelona and CIBERFES, ISCIII, Barcelona, Catalonia, Spain

    A. Diez-Perez & D. Prieto-Alhambra

  7. MRC Lifecourse Epidemiology Unit, Southampton University, Southampton, UK

    D. Prieto-Alhambra

  8. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford NIHR Musculoskeletal Biomedical Research Centre, University of Oxford, Oxford, UK

    D. Prieto-Alhambra

  9. Musculoskeletal Pharmaco and Device Epidemiology, Botnar Research Centre, Nuffield Orthopaedics Centre, Windmill Road, Oxford, OX3 7LD, UK

    D. Prieto-Alhambra

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  1. D. Martinez-Laguna
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  2. X. Nogues
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  3. B. Abrahamsen
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  4. C. Reyes
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  5. C. Carbonell-Abella
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  7. D. Prieto-Alhambra
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Correspondence to D. Prieto-Alhambra.

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Conflicts of interest

DPA has received unrelated research grants from AMGEN, Laboratoires Servier, and UCB Pharmaceuticals. ADP has received unrelated support as speaker or advisor from Amgen, Lilly, UCB, Radius, Mereo and Active Life, and institutional research support from Amgen. BA reports institutional research contracts with Novartis and UCB Pharmaceuticals for epidemiological and pharmacovigilance studies.

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Martinez-Laguna, D., Nogues, X., Abrahamsen, B. et al. Excess of all-cause mortality after a fracture in type 2 diabetic patients: a population-based cohort study. Osteoporos Int 28, 2573–2581 (2017). https://doi.org/10.1007/s00198-017-4096-y

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  • DOI: https://doi.org/10.1007/s00198-017-4096-y

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