Oral Virtual Presentation (Virtual only) ESA-SRB-ANZBMS 2021

Type 2 diabetes, fracture risk and mortality in two longitudinal population-based studies: Dubbo Osteoporosis Epidemiology Study (DOES) and the Canadian Multicentre osteoporosis study (CaMos) (#143)

Nithin Kolanu 1 2 3 , Dana Bliuc 1 4 , Angela Sheu 1 4 5 , Robert D Blank 1 4 , Jonathan D Adachi 6 , Claudie Berger 7 , David Goltzman 8 , David A Hanley 9 , Robert G Josse 10 , Stephanie M Kaiser 11 , Christopher S Kovacs 12 , Jerilynn C Prior 13 , Thach Tran 1 4 , Jackie R Center 1 4 5
  1. Garvan Institute of Medical Research, Sydney, NSW
  2. Australian National University, Canberra, ACT, Australia
  3. Diabetes and Endocrinology, The Canberra Hospital, Garran, ACT, Australia
  4. University of New South Wales, Sydney, NSW, Australia
  5. Endocrinology, St Vincent's Hospital, Sydney, NSW
  6. Department of Medicine, McMaster University, Hamilton, Canada
  7. Canadian Multicentre Osteoporosis Study (CaMos), Research Institute of the McGill University Health Centre, Montreal, Canada
  8. Department of Medicine, McGill University, Montreal, Canada
  9. Department of Medicine, University of Calgary, Calgary, Canada
  10. Department of Medicine, University of Toronto, Toronto, Canada
  11. Department of Medicine, Dalhousie University, Halifax, Canada
  12. Faculty of Medicine, Memorial University, St. John's, Canada
  13. Department of Medicine and Endocrinology, University of British Columbia, Vancouver, Canada

Type 2 diabetes (T2DM), osteoporosis and fracture are increasingly prevalent. Effect of T2DM on fractures and post-fracture outcomes remains unclear. This study examined the effect of T2DM on initial fracture, subsequent fracture and post-fracture mortality risk in elderly individuals in a combined cohort of the Dubbo Osteoporosis Epidemiological Study (DOES) and Canadian Multicentre Osteoporosis study (CaMos).

The study followed 9275 community-dwelling adults (6363 women) aged 60+ years over 13 years (IQR:7-15.1). DOES had fewer participants (39%) but longer follow-up (14 vs 11 years) compared to CaMos. Fractures were radiologically verified. Baseline and incident self-reported T2DM status was confirmed with medication use where available. We analysed T2DM as a time-dependent predictor using Cox’s proportional hazards regression in gender-specific models with adjustment for known confounding factors. First fracture, subsequent fracture and post-fracture mortality were compared between those with and without diabetes.

T2DM was present in 471/2912 (16%) men and 782/6363 (12%) women (including incident T2DM in 159 men and 289 women). Fracture incidence was lower in both men and women with T2DM than those without (11% vs 15% men; 24% vs 29% women, respectively). Femoral neck bone mineral density (FNBMD) was significantly higher in women with T2DM compared to those without T2DM (p <0.01). T2DM was not associated with increased risk of first or subsequent fracture in age-adjusted or after accounting for all potential confounding effects in either women or men (Figure). However, T2DM was associated with increased risk of post-fracture mortality in men (HR 1.95; 95%CI:1.23-3.11) but not in women (1.32; 0.95-1.81).

Women and men with T2DM have similar fracture rates to those without T2DM. After a fracture, mortality in women is similar between T2DM and non-diabetes subjects whereas mortality in men is further increased by T2DM. Fracture risk reduction is therefore important in men and women with T2DM.

611fb60487777-Capture.JPG