Fractures in type 2 diabetes confer excess mortality: The Dubbo osteoporosis epidemiology study.

Sheu, A; Bliuc, D; Tran, T; White, CP; Center, JR

Fractures in type 2 diabetes confer excess mortality: The Dubbo osteoporosis epidemiology study.

Sheu, A Bliuc, D Tran, T White, CP Center, JR

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Publisher:: ELSEVIER SCIENCE INC
Publication Type:: Journal Article
Citation:: Bone, 2022, 159, pp. 116373
Issue Date:: 2022-06

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Field	Value	Language
dc.contributor.author	Sheu, A
dc.contributor.author	Bliuc, D
dc.contributor.author	Tran, T
dc.contributor.author	White, CP
dc.contributor.author	Center, JR
dc.date.accessioned	2023-03-19T08:59:18Z
dc.date.available	2022-02-21
dc.date.available	2023-03-19T08:59:18Z
dc.date.issued	2022-06
dc.identifier.citation	Bone, 2022, 159, pp. 116373
dc.identifier.issn	8756-3282
dc.identifier.issn	1873-2763
dc.identifier.uri	http://hdl.handle.net/10453/167540
dc.description.abstract	PURPOSE: Diabetes and fractures are both associated with increased mortality, however the effect of the combination is not well-established. We examined the mortality risk following all types of fractures in type 2 diabetes (T2D). METHODS: In the Dubbo Osteoporosis Epidemiology Study (1989-2017), participants were grouped according to T2D and/or incident fracture. Study outcome was all-cause mortality. First incident radiological fragility fracture and incident T2D diagnosis were time-dependent variables. Cox's proportional hazards models quantified mortality risk associated with T2D and incident fracture overall, as well as by fracture site, T2D duration and T2D medication type. RESULTS: In 3618 participants (62% women), 272 had baseline and 179 developed T2D over median 13.0 years (IQR 8.2-19.6). 796 women (56 with T2D) and 240 men (25 with T2D) sustained a fracture. Compared to those without T2D or fracture, mortality risk increased progressively, in T2D without fracture, then no T2D with fracture, and was highest in those with T2D with fracture (adjusted hazard ratio (aHR) (95% CI) for women 2.62 (1.75-3.93) and men 2.61 (1.42-4.81)). Within T2D participants, incident fracture was associated with increased mortality (aHR for women 1.87 (1.10-3.16) and men 2.83 (1.41-5.68)), especially following hip/vertebral fractures in men (aHR 2.97 (1.29-6.83)) and non-hip non-vertebral fractures in women (aHR 2.42 (1.24-4.75)), and in T2D duration >5 years. CONCLUSION: Any fracture in T2D conferred significant excess mortality. Individuals with T2D should be carefully monitored post-fracture, especially if T2D >5 years. Optimising fracture prevention and post-fracture management in T2D is critical and warrants further studies.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	ELSEVIER SCIENCE INC
dc.relation	http://purl.org/au-research/grants/nhmrc/1070187
dc.relation.ispartof	Bone
dc.relation.isbasedon	10.1016/j.bone.2022.116373
dc.rights	info:eu-repo/semantics/closedAccess
dc.subject	06 Biological Sciences, 09 Engineering, 11 Medical and Health Sciences
dc.subject.classification	Endocrinology & Metabolism
dc.subject.mesh	Bone Density
dc.subject.mesh	Diabetes Mellitus, Type 2
dc.subject.mesh	Female
dc.subject.mesh	Hip Fractures
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Multiple Endocrine Neoplasia Type 2a
dc.subject.mesh	Osteoporosis
dc.subject.mesh	Osteoporotic Fractures
dc.subject.mesh	Risk Factors
dc.subject.mesh	Humans
dc.subject.mesh	Multiple Endocrine Neoplasia Type 2a
dc.subject.mesh	Osteoporosis
dc.subject.mesh	Diabetes Mellitus, Type 2
dc.subject.mesh	Hip Fractures
dc.subject.mesh	Risk Factors
dc.subject.mesh	Bone Density
dc.subject.mesh	Female
dc.subject.mesh	Male
dc.subject.mesh	Osteoporotic Fractures
dc.subject.mesh	Bone Density
dc.subject.mesh	Diabetes Mellitus, Type 2
dc.subject.mesh	Female
dc.subject.mesh	Hip Fractures
dc.subject.mesh	Humans
dc.subject.mesh	Male
dc.subject.mesh	Multiple Endocrine Neoplasia Type 2a
dc.subject.mesh	Osteoporosis
dc.subject.mesh	Osteoporotic Fractures
dc.subject.mesh	Risk Factors
dc.title	Fractures in type 2 diabetes confer excess mortality: The Dubbo osteoporosis epidemiology study.
dc.type	Journal Article
utslib.citation.volume	159
utslib.location.activity	United States
utslib.for	06 Biological Sciences
utslib.for	09 Engineering
utslib.for	11 Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology
pubs.organisational-group	/University of Technology Sydney/Faculty of Engineering and Information Technology/School of Biomedical Engineering
utslib.copyright.status	closed_access	*
dc.date.updated	2023-03-19T08:59:17Z
pubs.publication-status	Published
pubs.volume	159

Abstract:

PURPOSE: Diabetes and fractures are both associated with increased mortality, however the effect of the combination is not well-established. We examined the mortality risk following all types of fractures in type 2 diabetes (T2D). METHODS: In the Dubbo Osteoporosis Epidemiology Study (1989-2017), participants were grouped according to T2D and/or incident fracture. Study outcome was all-cause mortality. First incident radiological fragility fracture and incident T2D diagnosis were time-dependent variables. Cox's proportional hazards models quantified mortality risk associated with T2D and incident fracture overall, as well as by fracture site, T2D duration and T2D medication type. RESULTS: In 3618 participants (62% women), 272 had baseline and 179 developed T2D over median 13.0 years (IQR 8.2-19.6). 796 women (56 with T2D) and 240 men (25 with T2D) sustained a fracture. Compared to those without T2D or fracture, mortality risk increased progressively, in T2D without fracture, then no T2D with fracture, and was highest in those with T2D with fracture (adjusted hazard ratio (aHR) (95% CI) for women 2.62 (1.75-3.93) and men 2.61 (1.42-4.81)). Within T2D participants, incident fracture was associated with increased mortality (aHR for women 1.87 (1.10-3.16) and men 2.83 (1.41-5.68)), especially following hip/vertebral fractures in men (aHR 2.97 (1.29-6.83)) and non-hip non-vertebral fractures in women (aHR 2.42 (1.24-4.75)), and in T2D duration >5 years. CONCLUSION: Any fracture in T2D conferred significant excess mortality. Individuals with T2D should be carefully monitored post-fracture, especially if T2D >5 years. Optimising fracture prevention and post-fracture management in T2D is critical and warrants further studies.

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http://hdl.handle.net/10453/167540