Prediabetes with pre-menopause transition increase fracture risk: JAMA

A new study by Albert Shieh and team showed that independent of bone mineral density (BMD), pre-menopause transition (MT) prediabetes was linked to a higher risk of recurrent fractures during the MT and after menopause. The findings of this study were published in the Journal of American Medical Association.

Fractures and diabetic bone disease are now widely acknowledged as end-organ consequences of diabetes. Whether prediabetes also increases the risk of fractures is unknown at this time. In order to determine if prediabetes before the menopausal transition is linked to incidence fracture during and after the MT, this study was carried out.

This cohort study employed data from the Study of Women's Health Across the Nation cohort project, which is an ongoing, multicenter, US-based, longitudinal investigation of the MT in different ambulatory women. The study comprised 1690 midlife women who were in premenopause or early perimenopause at the start of the trial (and have subsequently progressed to postmenopause), did not have type 2 diabetes prior to the MT, and did not use bone-beneficial drugs prior to the MT. The first visit in late perimenopause (or first postmenopausal visit if individuals moved directly from premenopause or early perimenopause to postmenopause) was considered as the start of the MT. The average (SD) length of follow-up was 12 (6) years. From January through May 2022, statistical analysis was carried out.

The key findings of this study were:

1. This study involved 1690 women.

2. A total of 225 women (13.3%) had prediabetes at one or more study visits prior to the MT, while 1465 women (86.7%) did not. 25 (11.1%) of the 225 women with prediabetes fractured, while 111 (7.6%) of the 1465 women without prediabetes fractured.

3. Prediabetes before the MT was related with more future fractures after adjusting for age, BMI, and cigarette use at the start of the MT; fracture before the MT; use of bone-detrimental drugs; race and ethnicity; and study location.

4. After adjusting for BMD at the start of the MT, this connection remained substantially unaltered.

Reference:

Shieh, A., Greendale, G. A., Cauley, J. A., Karvonen-Gutierrez, C. A., & Karlamangla, A. S. (2023). Prediabetes and Fracture Risk Among Midlife Women in the Study of Women’s Health Across the Nation. In JAMA Network Open (Vol. 6, Issue 5, p. e2314835). American Medical Association (AMA). https://doi.org/10.1001/jamanetworkopen.2023.14835