Renal Dysfunction Raises Risk of Vertebral Fractures in T2DM Patients, reveals study

The research enrolled T2DM patients aged 50 years and older with no baseline vertebral fractures identified on CT imaging between January 2019 and December 2021. The cohort was monitored yearly until January 2024. Vertebral fractures were defined according to the Genant score system. Patients were stratified on renal function in three categories: no renal dysfunction, eGFR decrease or proteinuria, and eGFR decrease + proteinuria. 135 patients developing new vertebral fractures were identified and matched with 270 control non-fracture patients, on follow-up time and body mass index. Associations were tested with Cox proportional hazards models.

Key Findings

• 135 patients developed new vertebral fractures with a median follow-up of 2 years.

Renal dysfunction substantially raised fracture risk:

• eGFR decline or proteinuria: Adjusted Hazard Ratio (HR) = 1.98, 95% CI: 1.35–2.92

• eGFR decline + proteinuria: Adjusted HR = 2.53, 95% CI: 1.30–4.92

• Decreased bone CT attenuation (HU) was also associated with fracture risk: Adjusted HR = 0.97, 95% CI: 0.99–0.99

Subgroup analysis demonstrated that this correlation was more pronounced in:

Women

• Non-diabetic neuropathy patients

• Non-vascular complication patients

• Non-insulin therapy patients

Adding renal dysfunction enhanced prediction models:

• AUC increased from 0.817 (95% CI: 0.78–0.85) to 0.839 (95% CI: 0.80–0.87) (p < 0.05)

This longitudinal analysis concludes that renal dysfunction is a standalone risk factor for vertebral fractures among type 2 diabetic patients. Incorporating renal markers like eGFR deterioration and proteinuria greatly enhanced the performance of clinical models to predict fracture risk.

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