Longer Diabetes duration, Strict Glycemic Control Linked to Increased Fracture Risk at Specific Sites: Study

The study found that a diabetes duration exceeding 10 years significantly elevated the risk of fractures, including major osteoporotic and hip fractures. However, a duration of over 8 years also raised the risk of hip fractures. Additionally, an HbA1c level below 6% was associated with a higher fracture risk compared to levels ranging from 6% to 7%. The presence of microvascular complications further contributed to the increased risk of fractures.

Johanna H. M. Driessen, Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+ (MUMC+), Maastricht, The Netherlands, and colleagues aimed to determine the association of diabetes-related characteristics with fractures at different sites in individuals with type 2 diabetes.

For this purpose, the researchers conducted a cohort study utilizing the Clinical Practice Research Datalink (CPRD) GOLD. They identified patients over 30 with T2D from the CPRD database. They tracked them from the initiation of diabetes treatment until the end of data collection, death, or the occurrence of a fracture.

Cox proportional hazards models were employed to estimate hazard ratios for the association between individual characteristics—such as diabetes duration, glycated hemoglobin (HbA1c) levels, and microvascular complications—and fracture risk. These models were adjusted for demographics, comorbidities, and concurrent medications.

The following were the key findings of the study:

• A diabetes duration of >10 years was associated with an increased risk of any fracture and major osteoporotic fractures (MOFs), while a diabetes duration of >8 years was associated with an increased hip fracture risk, compared to a duration of <2 years.
• An HbA1c level <6% was associated with an increased fracture risk compared to HbA1c values of 6% to <7%.
• The presence of one or two microvascular complications was associated with an increased risk of any fracture and MOFs and the presence of two microvascular complications was associated with an increased hip fracture risk, compared to no microvascular complications.

The study demonstrates that having type 2 diabetes for 10 years or more, achieving strict glycemic control with HbA1c levels below 6%, and having at least one microvascular complication are associated with an increased risk of various fractures, including any fracture, hip fractures, MOFs, and humerus fractures. However, these factors did not show a significant association with ankle, scapula, or skull fractures.

"These findings underscore the complex relationship between type 2 diabetes and bone health. The increased fracture risk linked to prolonged diabetes duration, stringent glycemic control, and microvascular complications suggests that individuals with type 2 diabetes may need targeted strategies to mitigate bone-related risks," the researchers concluded.

Reference:

DOI: https://doi.org/10.1111/dom.15884