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Frailty, diabetes increase fragility fracture risk



Despite having higher bone mineral density, patients with type 2 diabetes were frailer than were those without diabetes, increasing their risk of fragility fracture, according to findings from a prospective cohort study.

A total of 3,149 participants (70% women) were included in the study, 138 (60% women) of whom had type 2 diabetes. The mean age was 65 years and mean follow-up was 9.2 years. Over the study period, 611 fragility fractures were reported, of which 35 were in patients with diabetes and 576 in patients without diabetes. Overall, 25.4% of patients with diabetes experienced a fragility fracture, compared with 19.1% of control patients. Diabetes was associated with a significantly increased risk of all fragility fractures (hazard ratio, 1.54). It was also significantly associated with risk of hip fracture (HR, 2.60) but not clinical spine fracture.

In a Cox model incorporating the interaction between frailty index (FI) scores and diabetes, there was a significant association between FI and overall fracture risk per 0.01-point FI increase (HR, 1.02; 95% confidence interval, 1.01-1.03) and per 0.10-point FI increase (HR, 1.19; 95% CI, 1.10-1.33). However, no interaction between frailty and diabetes was observed for hip or clinical spine fractures.

“Frailty status may aid in the understanding of the paradox and thus enhance the quality of assessment and care for diabetes,” wrote Guowei Li, MBBS, PhD, of McMaster University, Hamilton, Ont., and his colleagues, adding that “particular attention should be paid to diabetes as a risk factor for fragility fractures in those who are frail.”

Four study authors reported conflicts of interest with some pharmaceutical companies that manufacture therapies for osteoporosis.

SOURCE: Li G et al. Diabetes Care. 2019 Jan 28. doi: 10.2337/dc18-1965.

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