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Hypoglycaemia and type 1 diabetes are associated with an increased risk of fractures

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Abstract

Summary

People with diabetes have an increased risk of fractures, and in this study, the effect of hypoglycaemia and insulin on this risk was investigated. Type 1 diabetes and hypoglycaemia did increase the fracture risk, and prevention of hypoglycaemia is thus an important focus area in the prevention of fractures.

Introduction

Studies have shown that type 1 diabetes (T1D) and type 2 diabetes (T2D) are associated with increased risk of fractures. Especially, subjects with T1D have an increased risk of fractures. The purpose of this study was to investigate the association of T1D, hypoglycaemia and insulin on fracture risk.

Methods

A cohort study with T1D subjects (n = 19,896) and T2D subjects (n = 312,188) matched with subjects from the general populated (n = 996,252) and a nested case-control study with T1D subjects with fracture (n = 895) as cases and T1D subjects without (n = 2685) as controls were conducted based on subjects from the Danish National Patient Registry (DNPR).

Results

T1D (HR = 2.47, 95% CI 2.37 to 2.59), age (HR = 1.05, 95% CI 1.05 to 1.05), previous fracture (HR = 1.95, 95% CI 1.92 to 1.99) and being female (HR = 2.06, 95% CI 2.04 to 2.09) increased the risk of fractures. Also, T2D (HR = 1.14, 95% CI 1.11 to 1.18) increased the risk of proximal upper arm and shoulder fractures. T1D (HR = 2.41, 95% CI 2.20 to 2.65) increased the risk of hip and femoral region fractures. Hypoglycaemia (OR = 1.58, 95% CI 1.27 to 1.97) increased the risk of fractures, whereas insulin use did not change the risk.

Conclusions

Hypoglycaemic episodes are associated with increased fracture risk, and the frequency of hypoglycaemic episodes leading to hospital admission was above 16% for T1D subjects. Prevention of hypoglycaemia is thus an important focus area in the prevention of fractures.

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Authors and Affiliations

  1. Steno Diabetes Center North Denmark, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark

    M. H. Jensen & P. Vestergaard

  2. Department of Health Science and Technology, Aalborg University, Fredrik Bajers Vej 7, 9220, Aalborg, Denmark

    M. H. Jensen

  3. Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark

    P. Vestergaard

  4. Department of Endocrinology, Aalborg University Hospital, Hobrovej 19, 9100, Aalborg, Denmark

    P. Vestergaard

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  1. M. H. Jensen
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Correspondence to M. H. Jensen.

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PV has received unrestricted grants from MSD and Servier and travel grants from Amgen, Eli Lilly, Novartis, Sanofi-Aventis, and Servier.

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Jensen, M.H., Vestergaard, P. Hypoglycaemia and type 1 diabetes are associated with an increased risk of fractures. Osteoporos Int 30, 1663–1670 (2019). https://doi.org/10.1007/s00198-019-05014-6

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