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Lifetime risks of hip fracture in patients with type 2 diabetic: Taiwan Diabetes Study

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Abstract

Summary

This study is to estimate the lifetime risks of hip fracture in Chinese patients with type 2 diabetes.

Introduction

The lifetime risks of hip fracture have not been reported across the age spectrum in male adults and female adults with type 2 diabetes.

Methods

A retrospective cohort study was conducted on 25275 men and 27953 women with type 2 diabetes aged 30–100 years old and participated in the National Diabetes Case Management Program in 2002–2004 in Taiwan. Sociodemographic factors, biomarkers, and comorbidity at the baseline and hip fracture events were analyzed with Cox proportional hazards regression models with age as the time scale.

Results

Significant differences in the lifetime risks of hip fracture were observed between men and women with type 2 diabetes. The cumulative lifetime incidences (%) of hip fracture at 50, 60, 65, 70, 75, 80, and 85 years old for men were 0.11, 0.40, 0.84, 1.84, 3.82, 8.53, and 16.72, respectively. The corresponding lifetime incidences (%) for women at 50, 60, 65, 70, 75, 80, and 85 years old were 0.05, 0.50, 1.36, 3.89, 9.56, 21.19, and 35.45, respectively. With competing risks, the significant multivariate-adjusted hazard ratio of developing hip fracture included smoking, alcohol drinking, duration of diabetes, type of oral hypoglycemic drugs use (no medication, sulfonylurea only, thiazolidinediones (TZD) only or TZD plus others, other single or multiple oral agents, insulin use, insulin plus oral hypoglycemic drug use), loop diuretics use, use of corticosteroids, normal weight or underweight, hyperlipidemia, and chronic obstructive pulmonary disease.

Conclusions

The gender differences in lifetime hip fracture risk were significant. Thiazolidinediones and insulin use are factors with the greater magnitude of strength of association among those significantly associated with hip fracture.

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Abbreviations

DM:

Diabetes mellitus

FPG:

Fasting plasma glucose

NDCMP:

Nation Diabetes Case Management Program

ICD-9-CM:

International Classification of Diseases, Ninth Revision, Clinical Modification

LHID2000:

Longitudinal Health Insurance Database 2000

NHIRD:

National Health Insurance Research Database

NHI:

National Health Insurance

NHIP:

National Health Insurance Program

PIN:

Personal identification number

TZD:

Thiazolidinediones

RAS:

Renin-angiotensin system

BBs:

Beta blocking agents

CCBs:

Calcium channel blockers

CHF :

Congestive heart failure

CAD:

Coronary artery disease

COPD:

Chronic obstructive pulmonary disease

BMI:

Body mass index

RANKL:

Receptor activator of nuclear factor-kappa B ligand

References

  1. Barnea R, Weiss Y, Abadi-Korek I, Shemer J (2018) The epidemiology and economic burden of hip fractures in Israel. Isr J Health Policy Res 7:38–38

    Article  Google Scholar 

  2. Boonen S, Autier P, Barette M, Vanderschueren D, Lips P, Haentjens P (2004) Functional outcome and quality of life following hip fracture in elderly women: a prospective controlled study. Osteoporos Int 15:87–94

    Article  Google Scholar 

  3. Keene GS, Parker MJ, Pryor GA (1993) Mortality and morbidity after hip fractures. BMJ 307:1248–1250

    Article  CAS  Google Scholar 

  4. Vestergaard P, Rejnmark L, Mosekilde L (2007) Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int 18:1583–1593

    Article  CAS  Google Scholar 

  5. Cree M, Soskolne CL, Belseck E, Hornig J, McElhaney JE, Brant R, Suarez-Almazor M (2000) Mortality and institutionalization following hip fracture. J Am Geriatr Soc 48:283–288

    Article  CAS  Google Scholar 

  6. Reginster JY, Gillet P, Ben Sedrine W, Brands G, Ethgen O, de Froidmont C, Gosset C (1999) Direct costs of hip fractures in patients over 60 years of age in Belgium. Pharmacoeconomics 15:507–514

    Article  CAS  Google Scholar 

  7. Autier P, Haentjens P, Bentin J, Baillon JM, Grivegnée AR, Closon MC, Boonen S (2000) Costs induced by hip fractures: a prospective controlled study in Belgium. Belgian Hip Fracture Study Group. Osteoporos Int 11:373–380

    Article  CAS  Google Scholar 

  8. Ström O, Borgström F, Kanis JA, Compston J, Cooper C, McCloskey EV, Jönsson B (2011) Osteoporosis: burden, health care provision and opportunities in the EU: a report prepared in collaboration with the International Osteoporosis Foundation (IOF) and the European Federation of Pharmaceutical Industry Associations (EFPIA). Arch Osteoporos 6:59–155

    Article  Google Scholar 

  9. 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 

  10. Robbins J, Aragaki AK, Kooperberg C, Watts N, Wactawski-Wende J, Jackson RD, LeBoff MS, Lewis CE, Chen Z, Stefanick ML, Cauley J (2007) Factors associated with 5-year risk of hip fracture in postmenopausal women. Jama 298:2389–2398

    Article  CAS  Google Scholar 

  11. Chiang JIH, Li TC, Li CI, Liu CS, Meng NH, Lin WY, Yang SY, Chen HJ, Lin CC (2016) Visit-to-visit variation of fasting plasma glucose is a predictor of hip fracture in older persons with type 2 diabetes: the Taiwan Diabetes Study. Osteoporos Int 27:3587–3597

    Article  CAS  Google Scholar 

  12. Li CI, Liu CS, Lin WY, Meng NH, Chen CC, Yang SY, Chen HJ, Lin CC, Li TC (2015) Glycated hemoglobin level and risk of hip fracture in older people with type 2 diabetes: a competing risk analysis of Taiwan Diabetes Cohort Study. J Bone Miner Res 30:1338–1346

    Article  Google Scholar 

  13. Pérez-Castrillón JL, Martín-Escudero JC, Alvarez Manzanares P, Cortés Sancho R, Iglesias Zamora S, García Alonso M (2005) Hypertension as a risk factor for hip fracture. Am J Hypertens 18:146–147

    Article  Google Scholar 

  14. Li TC, Li CI, Liu CS, Lin WY, Lin CH, Yang SY, Chiang JH, Lin CC (2019) Visit-to-visit blood pressure variability and hip fracture risk in older persons. Osteoporos Int 30:763–770

    Article  Google Scholar 

  15. Chen HF, Ho CA, Li CY (2008) Increased risks of hip fracture in diabetic patients of Taiwan: a population-based study. Diabetes Care 31:75–80

    Article  CAS  Google Scholar 

  16. Wang J, Wang Y, Liu WD, Wang F, Yin ZS (2014) Hip fractures in Hefei, China: the Hefei osteoporosis project. J Bone Miner Metab 32:206–214

    Article  CAS  Google Scholar 

  17. Zhang C, Feng J, Wang S, Gao P, Xu L, Zhu J, Jia J, Liu L, Liu G, Wang J, Zhan S, Song C (2020) Incidence of and trends in hip fracture among adults in urban China: a nationwide retrospective cohort study. PLoS Med 17:e1003180

    Article  Google Scholar 

  18. NHI (2010) The National Health Insurance Statistics, 2010. http://www.nhi.gov.tw/English/webdata/webdata.aspx?menu=11&menuid=296&WD_ID=296&webdataid=4010. Accessed October 2020

  19. Wu VC, Huang TM, Wu PC, Wang WJ, Chao CT, Yang SY, Shiao CC, Hu FC, Lai CF, Lin YF, Han YY, Chen YS, Hsu RB, Young GH, Wang SS, Tsai PR, Chen YM, Chao TT, Ko WJ, Wu KD, the NSARF Group (2012) Preoperative proteinuria is associated with long-term progression to chronic dialysis and mortality after coronary artery bypass grafting surgery. PLoS One 7:e27687

    Article  CAS  Google Scholar 

  20. Chen TT, Chung KP, Lin IC, Lai MS (2011) The unintended consequence of diabetes mellitus pay-for-performance (P4P) program in Taiwan: are patients with more comorbidities or more severe conditions likely to be excluded from the P4P program? Health Serv Res 46:47–60

    Article  Google Scholar 

  21. Schwartz AV, Sellmeyer DE, Vittinghoff E, Palermo L, Lecka-Czernik B, Feingold KR, Strotmeyer ES, Resnick HE, Carbone L, Beamer BA, Park SW, Lane NE, Harris TB, Cummings SR (2006) Thiazolidinedione use and bone loss in older diabetic adults. J Clin Endocrinol Metab 91:3349–3354

    Article  CAS  Google Scholar 

  22. García-Hernández A, Arzate H, Gil-Chavarría I, Rojo R, Moreno-Fierros L (2012) High glucose concentrations alter the biomineralization process in human osteoblastic cells. Bone 50:276–288

    Article  Google Scholar 

  23. Creely SJ, McTernan PG, Kusminski CM, Fisher FM, Da Silva NF, Khanolkar M, Evans M, Harte AL, Kumar S (2007) Lipopolysaccharide activates an innate immune system response in human adipose tissue in obesity and type 2 diabetes. Am J Phys Endocrinol Metab 292:E740–E747

    Article  CAS  Google Scholar 

  24. Vitseva OI, Tanriverdi K, Tchkonia TT, Kirkland JL, McDonnell ME, Apovian CM, Freedman J, Gokce N (2008) Inducible Toll-like receptor and NF-kappaB regulatory pathway expression in human adipose tissue. Obesity (Silver Spring, Md) 16:932–937

    Article  CAS  Google Scholar 

  25. Duque G, Troen BR (2008) Understanding the mechanisms of senile osteoporosis: new facts for a major geriatric syndrome. J Am Geriatr Soc 56:935–941

    Article  Google Scholar 

  26. Lu H, Kraut D, Gerstenfeld LC, Graves DT (2003) Diabetes interferes with the bone formation by affecting the expression of transcription factors that regulate osteoblast differentiation. Endocrinology 144:346–352

    Article  CAS  Google Scholar 

  27. Pittas AG, Harris SS, Stark PC, Dawson-Hughes B (2007) The effects of calcium and vitamin D supplementation on blood glucose and markers of inflammation in nondiabetic adults. Diabetes Care 30:980–986

    Article  CAS  Google Scholar 

  28. Oei L, Zillikens MC, Dehghan A, Buitendijk GHS, Castano-Betancourt MC, Estrada K, Stolk L, Oei EHG, van Meurs JBJ, Janssen JAMJL, Hofman A, van Leeuwen JPTM, Witteman JCM, Pols HAP, Uitterlinden AG, Klaver CCW, Franco OH, Rivadeneira F (2013) High bone mineral density and fracture risk in type 2 diabetes as skeletal complications of inadequate glucose control: the Rotterdam Study. Diabetes Care 36:1619–1628

    Article  CAS  Google Scholar 

  29. de Liefde II, van der Klift M, de Laet CE, van Daele PL, Hofman A, Pols HA (2005) Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos Int 16:1713–1720

    Article  Google Scholar 

  30. Schwartz AV, Hillier TA, Sellmeyer DE, Resnick HE, Gregg E, Ensrud KE, Schreiner PJ, Margolis KL, Cauley JA, Nevitt MC, Black DM, Cummings SR (2002) Older women with diabetes have a higher risk of falls: a prospective study. Diabetes Care 25:1749–1754

    Article  Google Scholar 

  31. Wei TS, Hu CH, Wang SH, Hwang KL (2001) Fall characteristics, functional mobility and bone mineral density as risk factors of hip fracture in the community-dwelling ambulatory elderly. Osteoporos Int 12:1050–1055

    Article  CAS  Google Scholar 

  32. Yaturu S, Humphrey S, Landry C, Jain SK (2009) Decreased bone mineral density in men with metabolic syndrome alone and with type 2 diabetes. Medical science monitor 15:Cr5-9

  33. von Muhlen D, Safii S, Jassal SK, Svartberg J, Barrett-Connor E (2007) Associations between the metabolic syndrome and bone health in older men and women: the Rancho Bernardo Study. Osteoporos Int 18:1337–1344

    Article  Google Scholar 

  34. Lidfeldt J, Holmdahl L, Samsioe G, Nerbrand C, Nyberg P, Scherstén B, Agardh CD (2002) The influence of hormonal status and features of the metabolic syndrome on bone density: a population-based study of Swedish women aged 50 to 59 years. The women’s health in the Lund area study. Metabolism 51:267–270

  35. Massé PG, Tranchant CC, Dosy J, Donovan SM (2005) Coexistence of osteoporosis and cardiovascular disease risk factors in apparently healthy, untreated postmenopausal women. Int J Vitam Nutr Res 75:97–106

  36. Pelton K, Krieder J, Joiner D, Freeman MR, Goldstein SA, Solomon KR (2012) Hypercholesterolemia promotes an osteoporotic phenotype. Am J Pathol 181:928–936

    Article  Google Scholar 

  37. Schneider LE, Nowosielski LM, Schedl HP (1977) Insulin-treatment of diabetic rats: effects on duodenal calcium absorption. Endocrinology 100:67–73

    Article  CAS  Google Scholar 

  38. Alvarez JA, Ashraf A (2010) Role of vitamin d in insulin secretion and insulin sensitivity for glucose homeostasis. Int J Endocrinol 2010:351385

    Article  Google Scholar 

  39. Mo D, Hsieh P, Yu H, Zhou L, Gong J, Xu L, Liu P, Chen G, Chen Z, Deng Q (2017) The relationship between osteoporosis and body composition in pre- and postmenopausal women from different ethnic groups in China. Ethn Health 22:295–310

    Article  Google Scholar 

  40. Vijayakumar R, Büsselberg D (2016) Osteoporosis: an under-recognized public health problem. J Local Glob Health Sci 2016:1–13

    Google Scholar 

Download references

Acknowledgments

This study was supported primarily by the Bureau of National Health Insurance (DOH94-NH-1007), the Ministry of Science and Technology of Taiwan (MOST 107-2314-B-039-049- & MOST 108-2314-B-039-039- & MOST 108-2314-B-039-035-MY3 & MOST 108-2314-B-039-031-MY2 & MOST 109-2314-B-039-031 -MY2), and China Medical University Hospital (DMR-109-243).

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Authors and Affiliations

  1. School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan

    C.-C. Lin, C.-I. Li, C.-S. Liu, M.-C. Wang, C.-H. Lin & W.-Y. Lin

  2. Department of Family Medicine, China Medical University Hospital, Taichung, Taiwan

    C.-C. Lin, C.-S. Liu, M.-C. Wang, C.-H. Lin & W.-Y. Lin

  3. Department of Medical Research, China Medical University Hospital, Taichung, Taiwan

    C.-C. Lin, C.-I. Li & C.-S. Liu

  4. Department of Public Health, College of Public Health, China Medical University, No. 100, Sec. 1, Jingmao Rd., Beitun Dist, Taichung City, 406040, Taiwan, Republic of China

    S.-Y. Yang & T.-C. Li

  5. Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan

    T.-C. Li

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  1. C.-C. Lin
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Correspondence to T.-C. Li.

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Lin, CC., Li, CI., Liu, CS. et al. Lifetime risks of hip fracture in patients with type 2 diabetic: Taiwan Diabetes Study. Osteoporos Int 32, 2571–2582 (2021). https://doi.org/10.1007/s00198-021-06052-9

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  • DOI: https://doi.org/10.1007/s00198-021-06052-9

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