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Comparison of fracture risk between type 1 and type 2 diabetes: a comprehensive real-world data



Population-based cohort study of 6,548,784 Korean subjects demonstrates that the risk of fracture was higher in patients with diabetes than in nondiabetic subjects. Furthermore, patients with type 1 diabetes were associated with a higher risk of fracture than patients with type 2 diabetes for all measurement sites.


Diabetes mellitus is associated with increased fracture risk. Although the pathophysiologic effect on bone metabolism differs according to the type of diabetes, a higher risk of fracture in patients with diabetes than in nondiabetic patients has been consistently demonstrated. Considering the ever-increasing number of patients with diabetes, we aimed to provide updated information on whether this phenomenon remains valid in real-world settings by using large-scale population datasets.


We conducted a retrospective longitudinal study using data from the Korean National Health Insurance Service dataset of preventive health check-ups between January 2009 and December 2016. The hazard ratios were calculated for any fracture, vertebral fracture, and hip fracture and were analyzed according to the presence and type of diabetes. Among 10,585,818 subjects, 6,548,784 were eligible for the analysis (2418 patients with type 1 diabetes mellitus [T1DM] and 506,208 patients with type 2 diabetes mellitus [T2DM]).


The mean follow-up duration (in years) was 7.0 ± 1.3 for subjects without diabetes, 6.4 ± 2.0 for those with T1DM, and 6.7 ± 1.7 for T2DM. Patients with T1DM had a higher incidence rate for all types of fractures per 1000 person-years. The fully adjusted hazard ratios (HRs) for any fracture, vertebral fracture, and hip fracture were higher in T1DM than in T2DM (1.37 [95% confidence interval (CI): 1.23–1.52] for any fracture, 1.33 [95% CI: 1.09–1.63] for vertebral fracture, and 1.99 [95% CI: 1.56–2.53] for hip fracture).


In this large-scale population analysis, diabetes was associated with a higher risk of all types of fractures. Patients with T1DM had a higher risk of fracture than those with T2DM for all measurement sites, and hip fractures had the highest risk. Therefore, fracture prevention training for patients with diabetes is advisable.

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Data availability

The datasets used and analyzed during the study are available from the corresponding author on reasonable request.


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This work was performed using a database from the National Health Insurance Service, and the results do not necessarily represent the opinion of the National Health Insurance Service.

This study was made possible through the research support program of the Division of Endocrinology and Metabolism, College of Medicine, the Catholic University of Korea. We would like to express our gratitude to Professor Soon Jip Yoo, the head of the division, who made this research possible.

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Corresponding author

Correspondence to K.-H. Baek.

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The study was approved by the Institutional Review Board of the Catholic Medical Center (No. KC20ZISI0291). The need for informed consent was waived by the review board because all data provided by the NHIS to researchers were deidentified.

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The authors declare no competing interests.

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Ha, J., Jeong, C., Han, KD. et al. Comparison of fracture risk between type 1 and type 2 diabetes: a comprehensive real-world data. Osteoporos Int (2021).

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  • Diabetes mellitus
  • Hip fractures
  • Spinal fractures