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Fracture risk in women with type II diabetes. Results from a historical cohort with fracture follow-up



To examine the independent association between type II diabetes and fracture risk in a population of predominantly postmenopausal women referred to a specialist clinic for osteoporosis evaluation.


Type II diabetes associated fracture risk were evaluated among to 229 patients with type II diabetes in a cohort of 6285 women followed on average (until major osteoporotic fracture (MOF), death or end of study) for 5.8 years. Information of fracture risk factors was obtained from a clinical database and from national registries.


An elevated fracture risk was present. Prevalent fractures (43.7 vs. 33.2%, p = 0.0010) and prevalent MOF (26.2 vs. 20.5% p = 0.038) were more common among patients with type II diabetes. The unadjusted incident fracture risk was increased with a higher relative risk of 42%. An elevated MOF hazard ratio was present (HR = 1.726, p = 0.0006). Adjustment for prevalent osteoporosis and other possible confounders did not change this finding (HR = 1.558, p = 0.0207).


An association between type II diabetes and an increased risk of MOF primarily driven by an increased hip fracture risk was documented. This finding was independent of the presence of osteoporosis. Clinicians need to be aware of and adjust for these findings when evaluating patients with diabetes. Additional research examining pathophysiological mechanisms are needed.

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The study was approved by relevant review authorities including Statens Serum Institute, the Danish Data Protection Agency and Statistics Denmark.

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Correspondence to Jakob Præst Holm.

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Conflict of interest

J.H. has participated as a subinvastigator in studies by Amgen and MSD and received payment for lectures by Amgen. L.H. has been giving lectures sponsored by: Novartis, Lilly, Takeda/Nycomed, Novo-Nordisk, Amgen, GlaxoSmithKline, Servier, MSD, Ferrosan, Pfizer, PharmaVinci and Renapharma. J.E.B.J.: Board membership in Amgen, Eli Lilly, MSD, Novartis, Nycomed. Payment for lectures by Amgen, Eli Lilly and MSD. T.J. declares that he has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Holm, J.P., Jensen, T., Hyldstrup, L. et al. Fracture risk in women with type II diabetes. Results from a historical cohort with fracture follow-up. Endocrine 60, 151–158 (2018).

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  • Fracture risk
  • Type II diabetes
  • Women’s health
  • Osteoporosis
  • Secondary osteoporosis