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Fracture risk in diabetic elderly men: the MrOS study

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Abstract

Aims/hypothesis

Diabetes mellitus is associated with increased fracture risk in women but few studies are available in men. To evaluate the relationship between diabetes and prospective non-vertebral fractures in elderly men, we used data from the Osteoporotic Fractures in Men (MrOS) study.

Methods

The MrOS enrolled 5,994 men (aged ≥65 years). Diabetes (ascertained by self-report, the use of medication for diabetes or an elevated fasting glucose level) was reported in 881 individuals, 80 of whom were using insulin. Hip and spine bone mineral density (BMD) was measured using dual x-ray absorptiometry (DXA). After recruitment, the men were followed for incident non-vertebral fractures using a triannual (3 yearly) questionnaire for an average of 9.1 (SD 2.7) years. The Cox proportional hazards model was used to assess the incident risk of fractures.

Results

In models adjusted for age, race, clinic site and total hip BMD, the risk of non-vertebral fracture was higher in men with diabetes compared with normoglycaemic men (HR 1.30, 95% CI 1.09, 1.54) and was elevated in men using insulin (HR 2.46, 95% CI 1.69, 3.59). Men with impaired fasting glucose did not have a higher risk of fracture compared with normoglycaemic men (HR 1.04, 95% CI 0.89, 1.21). After multivariable adjustment, the risk of non-vertebral fracture remained higher only among men with diabetes who were using insulin (HR 1.74, 95% CI 1.13, 2.69).

Conclusions/interpretation

Men with diabetes who are using insulin have an increased risk of non-vertebral fracture for a given age and BMD.

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Abbreviations

BMD:

Bone mineral density

CKD-EPI:

Chronic Kidney Disease Epidemiology Collaboration

DXA:

Dual energy x-ray absorptiometry

IFG:

Impaired fasting glucose

MrOS:

Osteoporotic Fractures in Men

PASE:

Physical Activity Scale for the Elderly

TZDs:

Thiazolidinediones

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Acknowledgements

The authors wish to thank C. C. Dant of Medcom Consulting for his expert assistance preparing this manuscript. The authors represent the Osteoporotic Fractures in Men (MrOS) research group.

Funding

The Osteoporotic Fractures in Men (MrOS) study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), the National Center for Research Resources (NCRR) and NIH Roadmap for Medical Research under the following grant numbers: U01 AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01AG18197, U01-AG027810, and UL1 RR024140. Glucose measurements were supported by a grant from the American ADA (1-04-JF-46, Strotmeyer ES).

Duality of interest

The authors declare that there is no duality of interest associated with this manuscript.

Contribution statement

NN was involved in the concept, in data interpretation and in writing the manuscript. KEE and ESS were involved in the concept and design of the study, the acquisition and interpretation of data and the critical review of the paper for important intellectual content. ARH, DES, TLD, EB-C, DCB, DMB, ESO and SRC took part in the acquisition and interpretation of the data and in revising the article for important intellectual content. LP was involved in data acquisition and analysis and in revising the article. AVS is the guarantor of the study and made substantial contributions to the conception and design of the study, to the analysis and interpretation of the data, and to revising the article critically for important intellectual content. All authors gave their approval of the final manuscript.

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Authors and Affiliations

  1. Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy

    Nicola Napoli

  2. Division of Bone and Mineral Diseases, Washington University, St Louis, MO, USA

    Nicola Napoli

  3. Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA, USA

    Elsa S. Strotmeyer

  4. Department of Medicine and Division of Epidemiology & Community Health, University of Minnesota, Minneapolis, MN, USA

    Kristine E. Ensrud

  5. Center for Chronic Disease Outcomes Research VA Health Care System, Minneapolis, MN, USA

    Kristine E. Ensrud

  6. School of Medicine, Johns Hopkins University, Baltimore, MD, USA

    Deborah E. Sellmeyer

  7. University of California, San Francisco, San Francisco, CA, USA

    Douglas C. Bauer, Lisa Palermo, Dennis M. Black & Ann V. Schwartz

  8. VA Palo Alto Health Care System, Palo Alto, CA, USA

    Andrew R. Hoffman

  9. University of California, San Diego, La Jolla, CA, USA

    Thuy-Tien L. Dam & Elizabeth Barrett-Connor

  10. Oregon Health & Science University, Portland, OR, USA

    Eric S. Orwoll

  11. California Pacific Medical Center, San Francisco, CA, USA

    Steven R. Cummings

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  1. Nicola Napoli
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  2. Elsa S. Strotmeyer
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  3. Kristine E. Ensrud
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  4. Deborah E. Sellmeyer
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  9. Lisa Palermo
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  13. Ann V. Schwartz
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Correspondence to Nicola Napoli.

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Napoli, N., Strotmeyer, E.S., Ensrud, K.E. et al. Fracture risk in diabetic elderly men: the MrOS study. Diabetologia 57, 2057–2065 (2014). https://doi.org/10.1007/s00125-014-3289-6

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  • DOI: https://doi.org/10.1007/s00125-014-3289-6

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