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Association of type 2 diabetes and an inflammatory marker with incident bone fracture among a Japanese cohort

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      There are various causes of incident bone fracture. Not only aging, low bone mineral density and history of previous fracture, but also diabetes mellitus and inflammation are regarded as risk factors for fracture. The purpose of the present study was to verify the association of glycemic control or one inflammatory marker with incident fracture in a large‐scale Japanese cohort.

      Materials and Methods

      The present study was carried out at the Hiroshima Atomic Bomb Casualty Council and included 6,556 participants (2,785 men and 3,771 women, aged 55–87 years) who underwent annual health examinations and were followed for 7.4 years. Information about incident fractures was collected at interviews. Participants were classified into three groups: normal, borderline and diabetes mellitus according to glycohemoglobin levels (treated diabetes patients were included in the diabetes mellitus group). Furthermore, participants were classified into four additional groups by glycemic control (diabetes mellitus or non‐diabetes mellitus) and C‐reactive protein ( CRP) levels (low or high). Hazard ratios ( HRs) of diabetes mellitus, CRP and their combined risk of incident fracture were evaluated.


      After adjusting for age, bone mineral density and previous fracture, CRP was associated with increased fracture risk (in men HR 1.04, 95% confidence interval [ CI]: 1.003–1.06; in women HR 1.07, 95% CI: 1.03–1.13), and diabetes mellitus predicted fracture risk in men ( HR 1.31, 95% CI: 1.02–1.51). Fracture risk was significantly higher among the diabetes mellitus with high CRP group compared with the non‐diabetes mellitus with low CRP group (in men HR 1.47, 95% CI: 1.02–1.98; in women HR 1.41, 95% CI: 1.04–1.92).


      Among a Japanese cohort, CRP measurements were helpful to detect high fracture risk in patients with type 2 diabetes mellitus.

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      Most cited references 35

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      To clarify the factors associated with prevention, diagnosis, and treatment of osteoporosis, and to present the most recent information available in these areas. From March 27-29, 2000, a nonfederal, nonadvocate, 13-member panel was convened, representing the fields of internal medicine, family and community medicine, endocrinology, epidemiology, orthopedic surgery, gerontology, rheumatology, obstetrics and gynecology, preventive medicine, and cell biology. Thirty-two experts from these fields presented data to the panel and an audience of 699. Primary sponsors were the National Institute of Arthritis and Musculoskeletal and Skin Diseases and the National Institutes of Health Office of Medical Applications of Research. MEDLINE was searched for January 1995 through December 1999, and a bibliography of 2449 references provided to the panel. Experts prepared abstracts for presentations with relevant literature citations. Scientific evidence was given precedence over anecdotal experience. The panel, answering predefined questions, developed conclusions based on evidence presented in open forum and the literature. The panel composed a draft statement, which was read and circulated to the experts and the audience for public discussion. The panel resolved conflicts and released a revised statement at the end of the conference. The draft statement was posted on the Web on March 30, 2000, and updated with the panel's final revisions within a few weeks. Though prevalent in white postmenopausal women, osteoporosis occurs in all populations and at all ages and has significant physical, psychosocial, and financial consequences. Risks for osteoporosis (reflected by low bone mineral density [BMD]) and for fracture overlap but are not identical. More attention should be paid to skeletal health in persons with conditions associated with secondary osteoporosis. Clinical risk factors have an important but poorly validated role in determining who should have BMD measurement, in assessing fracture risk, and in determining who should be treated. Adequate calcium and vitamin D intake is crucial to develop optimal peak bone mass and to preserve bone mass throughout life. Supplementation with these 2 nutrients may be necessary in persons not achieving recommended dietary intake. Gonadal steroids are important determinants of peak and lifetime bone mass in men, women, and children. Regular exercise, especially resistance and high-impact activities, contributes to development of high peak bone mass and may reduce risk of falls in older persons. Assessment of bone mass, identification of fracture risk, and determination of who should be treated are the optimal goals when evaluating patients for osteoporosis. Fracture prevention is the primary treatment goal for patients with osteoporosis. Several treatments have been shown to reduce the risk of osteoporotic fractures, including those that enhance bone mass and reduce the risk or consequences of falls. Adults with vertebral, rib, hip, or distal forearm fractures should be evaluated for osteoporosis and given appropriate therapy.
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        Diabetes affects bone metabolism. The hypothesis was that type 1 (T1D) and type 2 (T2D) affects BMD and fracture risk differently. Pubmed, Embase, and Web of Science were searched using the terms "diabetes", "fracture", and "bone mineral". Hip fracture risk was increased in T1D (RR = 6.94, 95% CI: 3.25-14.78, five studies) and T2D (1.38, 95% CI: 1.25-1.53, eight studies) compared to subjects without diabetes. The increase in relative hip fracture risk was significantly higher in T1D than in T2D. BMD Z-score was decreased in the spine (mean +/- SEM -0.22 +/- 0.01) and hip (-0.37 +/- 0.16) in T1D and increased in the spine (0.41 +/- 0.01) and hip (0.27 +/- 0.01) in T2D. A meta-regression showed that body mass index (BMI) was a major determinant for BMD in both the spine and hip. Glycated haemoglobin (HbA1C) was not linked to BMD. The increase in fracture risk was higher and BMD lower in patients with complications to diabetes. Hip fracture risk is increased in both T1D and T2D, whereas BMD is increased in T2D and decreased in T1D. A common factor such as complications may explain the increase in fracture risk, whereas BMI may ameliorate the increase in fracture risk in T2D.
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          2. Classification and Diagnosis of Diabetes.


            Author and article information

            [ 1 ] Department of Molecular and Internal Medicine Graduate School of Biomedical & Health Sciences Hiroshima University Hiroshima Japan
            [ 2 ] Health Management & Promotion Center Hiroshima Atomic Bomb Casualty Council Hiroshima Japan
            Author notes
            [* ] Correspondence

            Saeko Fujiwara

            Tel.: +81‐82‐243‐2451

            Fax: +81‐82‐241‐0414

            E‐mail address: s-fujiwara@

            J Diabetes Investig
            J Diabetes Investig
            Journal of Diabetes Investigation
            John Wiley and Sons Inc. (Hoboken )
            13 March 2017
            September 2017
            : 8
            : 5 ( doiID: 10.1111/jdi.2017.8.issue-5 )
            : 709-715
            28122172 5583964 10.1111/jdi.12632 JDI12632
            © 2017 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd

            This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.

            Figures: 1, Tables: 3, Pages: 7, Words: 5267
            Funded by: Health examination at the Health Management & Promotion Center
            Funded by: Hiroshima Atomic Bomb Casualty Council
            Original Article
            Clinical Science and Care
            Custom metadata
            September 2017
            Converter:WILEY_ML3GV2_TO_NLMPMC version:5.1.9 mode:remove_FC converted:05.09.2017


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