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Diabetes Care. 2019 Oct 28. pii: dc190925. doi: 10.2337/dc19-0925. [Epub ahead of print]

Vertebral Fractures in Individuals With Type 2 Diabetes: More Than Skeletal Complications Alone.

Author information

1
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
2
Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
3
Bone and Joint Department, Center of Bone Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
4
Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands.
5
Insitute of Social and Preventive Medicine, Bern, Switzerland.
6
Division of Rheumatology, Department of Medicine, Queen's University, Kingston, Ontario, Canada.
7
Division of Endocrinology and Metabolism, University of Toronto, Toronto, Ontario, Canada.
8
Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
9
Department of Medicine, McGill University, Montreal, Quebec, Canada.
10
Department of Radiology, University of British Columbia, Vancouver, British Columbia, Canada.
11
Endocrinology, Department of Medicine, University of British Columbia, Vancouver, Canada.
12
Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
13
The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, U.K.
14
Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands f.rivadeneira@erasmusmc.nl.

Abstract

OBJECTIVE:

We aimed to assess whether individuals with type 2 diabetes (T2D) have increased risk of vertebral fractures (VFs) and to estimate nonvertebral fracture and mortality risk among individuals with both prevalent T2D and VFs.

RESEARCH DESIGN AND METHODS:

A systematic PubMed search was performed to identify studies that investigated the relationship between T2D and VFs. Cohorts providing individual-participant data (IPD) were also included. Estimates from published summary data and IPD cohorts were pooled in a random-effects meta-analysis. Multivariate Cox-regression models were used to estimate nonvertebral fracture and mortality risk among individuals with T2D and VFs.

RESULTS:

Across 15 studies comprising 852,705 men and women, individuals with T2D had lower risk of prevalent (odds ratio [OR] 0.84 [95% CI 0.74-0.95]; I 2 = 0.0%; P het = 0.54) but increased risk of incident VFs (OR 1.35 [95% CI 1.27-1.44]; I 2 = 0.6%; P het = 0.43). In the IPD cohorts (N = 19,820), risk of nonvertebral fractures was higher in those with both T2D and VFs compared with those without T2D or VFs (hazard ratio [HR] 2.42 [95% CI 1.86-3.15]), with VFs (HR 1.73 [95% CI 1.32-2.27]), or T2D (HR 1.94 [95% CI 1.46-2.59]) alone. Individuals with both T2D and VFs had increased mortality compared with individuals without T2D and VFs (HR 2.11 [95% CI 1.72-2.59]) or with VFs alone (HR 1.84 [95% CI 1.49-2.28]) and borderline increased compared with individuals with T2D alone (HR 1.23 [95% CI 0.99-1.52]).

CONCLUSIONS:

Based on our findings, individuals with T2D should be systematically assessed for presence of VFs, and, as in individuals without T2D, their presence constitutes an indication to start osteoporosis treatment for the prevention of future fractures.

PMID:
31658976
DOI:
10.2337/dc19-0925

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