Renal Dysfunction Raises Risk of Vertebral Fractures in T2DM Patients
Researchers have demonstrated that renal impairment highly increases the risk of vertebral fracture among type 2 diabetes mellitus (T2DM) patients, according to data from a five-year longitudinal follow-up study. The research showed specific types of renal impairment such as low estimated glomerular filtration rate (eGFR) and proteinuria to be independently associated with a high fracture risk. These findings emphasize the need for closer follow-up and preventive measures for bone health in diabetic patients presenting with evidence of kidney disease. The study was published in Diabetes, Metabolic Syndrome and Obesity by Nandong Hu and colleagues.
T2DM is a proven risk factor for both chronic kidney disease and decreased bone mineral density. Vertebral fractures (VFs), typically silent but clinically significant, are more prevalent in this population. However, the direct longitudinal association between kidney impairment and vertebral fracture risk has rarely been explored. This study attempted to fill that gap by exploring the influence of different manifestations of renal dysfunction decrease in eGFR, proteinuria, or both on the risk of vertebral fractures in older persons with T2DM.
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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