Diabetes and risk of fracture-related hospitalization: the Atherosclerosis Risk in Communities Study.

Abstract

OBJECTIVE:

To examine the association between diabetes, glycemic control, and risk of fracture-related hospitalization in the Atherosclerosis Risk in Communities (ARIC) Study.

RESEARCH DESIGN AND METHODS:

Fracture-related hospitalization was defined using International Classification of Diseases, 9th revision, codes (733.1-733.19, 733.93-733.98, or 800-829). We calculated the incidence rate of fracture-related hospitalization by age and used Cox proportional hazards models to investigate the association of diabetes with risk of fracture after adjustment for demographic, lifestyle, and behavioral risk factors.

RESULTS:

There were 1,078 incident fracture-related hospitalizations among 15,140 participants during a median of 20 years of follow-up. The overall incidence rate was 4.0 per 1,000 person-years (95% confidence interval [CI], 3.8-4.3). Diagnosed diabetes was significantly and independently associated with an increased risk of fracture (adjusted hazard ratio [HR], 1.74; 95% CI, 1.42-2.14). There also was a significantly increased risk of fracture among persons with diagnosed diabetes who were treated with insulin (HR, 1.87; 95% CI, 1.15-3.05) and among persons with diagnosed diabetes with hemoglobin A1c (HbA1c) ≥8% (1.63; 1.09-2.44) compared with those with HbA1c <8%. Undiagnosed diabetes was not significantly associated with risk of fracture (HR, 1.12; 95% CI, 0.82-1.53).

CONCLUSIONS:

This study supports recommendations from the American Diabetes Association for assessment of fracture risk and implementation of prevention strategies in persons with type 2 diabetes, particularly those persons with poor glucose control.

• Authors: Andrea L C Schneider, Emma K Williams, Frederick L Brancati, Saul Blecker, Josef Coresh, Elizabeth Selvin
• Journal: Diabetes care (Diabetes Care) Vol. 36 Issue 5 Pg. 1153-8 (May 2013) ISSN: 1935-5548 [Electronic] United States
• PMID: 23248194 (Publication Type: Journal Article, Research Support, N.I.H., Extramural)

Chemical References

• Blood Glucose

Topics

• Atherosclerosis (epidemiology)
• Blood Glucose (metabolism)
• Diabetes Mellitus (epidemiology)
• Diabetes Mellitus, Type 2 (metabolism)
• Female
• Fractures, Bone (epidemiology)
• Hospitalization (statistics & numerical data)
• Humans
• Incidence
• Male
• Middle Aged
• Risk Factors