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      Investigating the risk of bone fractures in elderly patients with type 2 diabetes mellitus: a retrospective study

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          Abstract

          Background

          Elderly patients with type 2 diabetes mellitus (T2DM) experience fractures more frequently than elderly individuals without diabetes. Fractures requiring hospitalization greatly affect quality of life, and although elderly patients with T2DM have several risk factors associated with fractures, only a few studies have evaluated these in detail in the Asian population. We conducted a retrospective study of elderly patients with T2DM for evaluating factors associated with fracture risk.

          Methods

          We conducted a retrospective study using electronic medical records (EMR) of patients aged ≥65 years with T2DM who were admitted to a public general medical institute in central Tokyo, Japan. We evaluated factors associated with fractures necessitating hospitalization in elderly patients with T2DM characteristics and hypoglycemic agent use. Factors associated with fracture risk were identified using multivariable logistic regression analysis.

          Results

          A total of 2,112 elderly patients (age ≥ 65 years) with T2DM were analyzed. Among them, 69 (3.3%) patients had been hospitalized for fractures. Factors associated with fractures were female sex (OR, 3.46), eGFR < 60 ml / min / 1.73 m 2 (OR, 0.55), and thiazolidine use (OR, 4.28). Further, a separate analysis based on sex revealed that the use of thiazolidines was significantly associated with fracture risk in both sexes.

          Conclusions

          In elderly patients with T2DM, the key factor associated with fractures was the use of thiazolidines in both males and females. In this study, the use of thiazolidines was newly identified as a factor which increased the risk of fractures requiring hospitalization in elderly males. The study findings should be considered when hypoglycemic agents are selected for treating elderly patients with T2DM. Information bias, selection bias, and the effect of concomitant drugs may be the underlying reasons for why eGFR < 60 mL / min / 1.73 m 2 reduced the fracture risk. However, details are unknown, and additional investigations are needed.

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          Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture.

          Mohsen Janghorbani, Rob Van Dam, Walter C. Willett … (2007)
          The authors conducted a systematic review of published data on the association between diabetes mellitus and fracture. The authors searched MEDLINE through June 2006 and examined the reference lists of pertinent articles (limited to studies in humans). Summary relative risks and 95% confidence intervals were calculated with a random-effects model. The 16 eligible studies (two case-control studies and 14 cohort studies) included 836,941 participants and 139,531 incident cases of fracture. Type 2 diabetes was associated with an increased risk of hip fracture in both men (summary relative risk (RR) = 2.8, 95% confidence interval (CI): 1.2, 6.6) and women (summary RR = 2.1, 95% CI: 1.6, 2.7). Results were consistent between studies of men and women and between studies conducted in the United States and Europe. The association between type of diabetes and hip fracture incidence was stronger for type 1 diabetes (summary RR = 6.3, 95% CI: 2.6, 15.1) than for type 2 diabetes (summary RR = 1.7, 95% CI: 1.3, 2.2). Type 2 diabetes was weakly associated with fractures at other sites, and most effect estimates were not statistically significant. These findings strongly support an association between both type 1 and type 2 diabetes and increased risk of hip fracture in men and women.
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            High Bone Mineral Density and Fracture Risk in Type 2 Diabetes as Skeletal Complications of Inadequate Glucose Control

            Ling Oei, M. Carola Zillikens, Abbas Dehghan … (2013)
            OBJECTIVE Individuals with type 2 diabetes have increased fracture risk despite higher bone mineral density (BMD). Our aim was to examine the influence of glucose control on skeletal complications. RESEARCH DESIGN AND METHODS Data of 4,135 participants of the Rotterdam Study, a prospective population-based cohort, were available (mean follow-up 12.2 years). At baseline, 420 participants with type 2 diabetes were classified by glucose control (according to HbA1c calculated from fructosamine), resulting in three comparison groups: adequately controlled diabetes (ACD; n = 203; HbA1c <7.5%), inadequately controlled diabetes (ICD; n = 217; HbA1c ≥7.5%), and no diabetes (n = 3,715). Models adjusted for sex, age, height, and weight (and femoral neck BMD) were used to test for differences in bone parameters and fracture risk (hazard ratio [HR] [95% CI]). RESULTS The ICD group had 1.1–5.6% higher BMD, 4.6–5.6% thicker cortices, and −1.2 to −1.8% narrower femoral necks than ACD and ND, respectively. Participants with ICD had 47–62% higher fracture risk than individuals without diabetes (HR 1.47 [1.12–1.92]) and ACD (1.62 [1.09–2.40]), whereas those with ACD had a risk similar to those without diabetes (0.91 [0.67–1.23]). CONCLUSIONS Poor glycemic control in type 2 diabetes is associated with fracture risk, high BMD, and thicker femoral cortices in narrower bones. We postulate that fragility in apparently “strong” bones in ICD can result from microcrack accumulation and/or cortical porosity, reflecting impaired bone repair.
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              Diagnostic criteria for primary osteoporosis: year 2012 revision.

              Masao Fukunaga, Toshitsugu Sugimoto, Hiroaki Ohta … (2013)
              In 1995, the Japanese Society for Bone and Mineral Metabolism (now the Japanese Society for Bone and Mineral Research) established the Osteoporosis Diagnostic Criteria Review Committee. Following discussion held at the 13th scientific meeting of the Society in 1996, the Committee, with the consensus of its members, proposed diagnostic criteria for primary osteoporosis. The Committee revised those criteria in 1998 and again in 2000. The Japanese Society for Bone and Mineral Research and Japan Osteoporosis Society Joint Review Committee for the Revision of the Diagnostic Criteria for Primary Osteoporosis aimed at obtaining international consistency and made a revised edition based on the new findings in 2012.
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                Author and article information

                Contributors
                Takeshi Horii: 042-778-8089 , horiit@pharm.kitasato-u.ac.jp
                Makiko Iwasawa: iwasawam@pharm.kitasato-u.ac.jp
                Yusuke Kabeya: ykabeyan@yahoo.co.jp
                Jyunichi Shimizu: junichis@maple.ocn.ne.jp
                Koichiro Atsuda: atsudak@pharm.kitasato-u.ac.jp
                Journal
                Journal ID (nlm-ta): BMC Endocr Disord
                Journal ID (iso-abbrev): BMC Endocr Disord
                Title: BMC Endocrine Disorders
                Publisher: BioMed Central (London )
                ISSN (Electronic): 1472-6823
                Publication date (Electronic): 26 July 2019
                Publication date PMC-release: 26 July 2019
                Publication date Collection: 2019
                Volume: 19
                Electronic Location Identifier: 81
                Affiliations
                [1 ]ISNI 0000 0000 9206 2938, GRID grid.410786.c, Division of Clinical Pharmacy (Pharmacy Practice and Science I) and Research and Education Center for Clinical Pharmacy, , Kitasato University School of Pharmacy, ; 1-15-1 Kitasato, Minami Ward, Sagamihara City, Kanagawa Prefecture 252-0375 Japan
                [2 ]ISNI 0000 0000 9206 2938, GRID grid.410786.c, Division of Clinical Pharmacy (Laboratory of Drug Information) and Research and Education Center for Clinical Pharmacy, , Kitasato University School of Pharmacy, ; 1-15-1 Kitasato, Minami Ward, Sagamihara City, Kanagawa Prefecture 252-0375 Japan
                [3 ]Home Medical Care Department, Sowa Hospital, 1752 Oshima, Midori Ward, Sagamihara City, Kanagawa Prefecture 252-0135 Japan
                [4 ]ISNI 0000 0000 9225 8957, GRID grid.270560.6, Department of Pharmacy, , Tokyo Saiseikai Central Hospital, ; 1-4-17 Mita, Minato Ward, Tokyo, 108-0073 Japan
                Article
                Publisher ID: 413
                DOI: 10.1186/s12902-019-0413-0
                PMC ID: 6660921
                PubMed ID: 31349845
                SO-VID: 45f4f838-fbcb-450e-9a86-5e6bbcfae64a
                Copyright © © The Author(s). 2019
                License:

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                Date received : 25 April 2019
                Date accepted : 19 July 2019
                Categories
                Subject: Research Article
                Custom metadata
                issue-copyright-statement © The Author(s) 2019

                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: type 2 diabetes mellitus,bone fractures,antihyperglycemic agents
                Data availability:
                ScienceOpen disciplines: Endocrinology & Diabetes
                Keywords: type 2 diabetes mellitus, bone fractures, antihyperglycemic agents

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