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Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study
Se-Won Lee, Kyungdo Han, Hyuk-Sang Kwon
Diabetes Metab J. 2023;47(2):242-254.   Published online January 19, 2023
DOI: https://doi.org/10.4093/dmj.2022.0001
  • 3,254 View
  • 166 Download
  • 5 Web of Science
  • 4 Crossref
AbstractAbstract PDFSupplementary MaterialPubReader   ePub   
Background
Body mass index (BMI) is a risk factor for the type 2 diabetes (T2DM), and T2DM accompanies various complications, such as fractures. We investigated the effects of BMI and T2DM on fracture risk and analyzed whether the association varied with fracture locations.
Methods
This study is a nationwide population-based cohort study that included all people with T2DM (n=2,746,078) who received the National Screening Program during 2009–2012. According to the anatomical location of the fracture, the incidence rate and hazard ratio (HR) were analyzed by dividing it into four categories: vertebra, hip, limbs, and total fracture.
Results
The total fracture had higher HR in the underweight group (HR, 1.268; 95% CI, 1.228 to 1.309) and lower HR in the obese group (HR, 0.891; 95% CI, 0.882 to 0.901) and the morbidly obese group (HR, 0.873; 95% CI, 0.857 to 0.89), compared to reference (normal BMI group). Similar trends were observed for HR of vertebra fracture. The risk of hip fracture was most prominent, the risk of hip fracture increased in the underweight group (HR, 1.896; 95% CI, 1.178 to 2.021) and decreased in the obesity (HR, 0.643; 95% CI, 0.624 to 0.663) and morbidly obesity group (HR, 0.627; 95% CI, 0.591 to 0.665). Lastly, fracture risk was least affected by BMI for limbs.
Conclusion
In T2DM patients, underweight tends to increase fracture risk, and overweight tends to lower fracture risk, but association between BMI and fracture risk varied depending on the affected bone lesions.

Citations

Citations to this article as recorded by  
  • Dysuricemia—A New Concept Encompassing Hyperuricemia and Hypouricemia
    Naoyuki Otani, Motoshi Ouchi, Einosuke Mizuta, Asuka Morita, Tomoe Fujita, Naohiko Anzai, Ichiro Hisatome
    Biomedicines.2023; 11(5): 1255.     CrossRef
  • Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study (Diabetes Metab J 2023;47:242-54)
    Se-Won Lee, Kyungdo Han, Hyuk-Sang Kwon
    Diabetes & Metabolism Journal.2023; 47(3): 439.     CrossRef
  • Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study (Diabetes Metab J 2023;47:242-54)
    So Young Park
    Diabetes & Metabolism Journal.2023; 47(3): 437.     CrossRef
  • Effect of SGLT2 inhibitors on fractures, BMD, and bone metabolism markers in patients with type 2 diabetes mellitus: a systematic review and meta-analysis
    Xin Wang, Fengyi Zhang, Yufeng Zhang, Jiayi Zhang, Yingli Sheng, Wenbo Wang, Yujie Li
    Osteoporosis International.2023; 34(12): 2013.     CrossRef
Fracture Incidence and Risk of Osteoporosis in Female Type 2 Diabetic Patients in Korea
Jong Kwan Jung, Hyo Jeong Kim, Hong Kyu Lee, Sang Soo Kim, Chan Soo Shin, Jin Taek Kim
Diabetes Metab J. 2012;36(2):144-150.   Published online April 17, 2012
DOI: https://doi.org/10.4093/dmj.2012.36.2.144
  • 4,501 View
  • 40 Download
  • 15 Crossref
AbstractAbstract PDFPubReader   
Background

There are no published data regarding fracture risk in type 2 diabetic patients in Korea. In this study, we compared the fracture incidence and risk of osteoporosis of type 2 diabetic female patients with those in a non-diabetic hypertensive cohort.

Methods

The incidence of fracture in a type 2 diabetic cohort was compared with that in a non-diabetic hypertensive cohort over the course of 7 years. Female type 2 diabetic and non-diabetic hypertensive patients who visited Eulji General Hospital outpatient clinic from January 2004 to April 2004 were assigned to the diabetic cohort and the non-diabetic hypertensive cohort, respectively. Surveys on fracture event, use of anti-osteoporosis medications, and bone mineral density were performed.

Results

The number of fractures was 88 in the female diabetic cohort (n=1,268, 60.6±11.5 years) and 57 in the female non-diabetic hypertensive cohort (n=1,014, 61.4±11.7 years). The RR in the diabetic cohort was 1.38 (P=0.064; 95% confidence interval [CI], 0.98 to 1.94) when adjusted for age. Diabetic patients with microvascular complications (61.0%) showed a higher RR of 1.81 (P=0.014; 95% CI, 1.13 to 2.92) compared with those without these complications. The prevalence of osteoporosis was comparable between the groups, while use of anti-osteoporosis medication was more common in the diabetic cohort (12.8%) than in the hypertensive cohort (4.5%) (P<0.001).

Conclusion

In our study, a higher fracture risk was observed in female type 2 diabetics with microvascular complications. Special concern for this risk group is warranted.

Citations

Citations to this article as recorded by  
  • Research Progress on How to Prevent Osteoporosis in Diabetic Patients
    婷玉 牛
    Advances in Clinical Medicine.2022; 12(02): 1178.     CrossRef
  • Differences in the roles of types 1 and 2 diabetes in the susceptibility to the risk of fracture: a systematic review and meta-analysis
    Jiaqing Dou, Jing Wang, Qiu Zhang
    Diabetology & Metabolic Syndrome.2021;[Epub]     CrossRef
  • The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: A systematic review and meta-analysis update
    Tatiane Vilaca, Marian Schini, Susan Harnan, Anthea Sutton, Edith Poku, Isabel E. Allen, Steven R. Cummings, Richard Eastell
    Bone.2020; 137: 115457.     CrossRef
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    Jing Bai, Qian Gao, Chen Wang, Jia Dai
    Aging Clinical and Experimental Research.2020; 32(11): 2173.     CrossRef
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    Hao Wang, Ying Ba, Qian Xing, Jian-Ling Du
    BMJ Open.2019; 9(1): e024067.     CrossRef
  • The use of metformin, insulin, sulphonylureas, and thiazolidinediones and the risk of fracture: Systematic review and meta‐analysis of observational studies
    Khemayanto Hidayat, Xuan Du, Meng‐Jiao Wu, Bi‐Min Shi
    Obesity Reviews.2019; 20(10): 1494.     CrossRef
  • Bei Diabetikern an eine Osteoporose denken!
    Stephan Scharla
    MMW - Fortschritte der Medizin.2018; 160(21-22): 65.     CrossRef
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    Joanna Dytfeld, Michał Michalak
    Aging Clinical and Experimental Research.2017; 29(2): 301.     CrossRef
  • Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies
    P. Jia, L. Bao, H. Chen, J. Yuan, W. Liu, F. Feng, J. Li, H. Tang
    Osteoporosis International.2017; 28(11): 3113.     CrossRef
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    Kathryn Fisher, Lauren Griffith, Andrea Gruneir, Dilzayn Panjwani, Sima Gandhi, Li (Lisa) Sheng, Amiram Gafni, Patterson Chris, Maureen Markle-Reid, Jenny Ploeg
    Diabetes Research and Clinical Practice.2016; 122: 113.     CrossRef
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    Yong Jun Choi, Yoon-Sok Chung
    Osteoporosis and Sarcopenia.2016; 2(1): 20.     CrossRef
  • Epidemiology of fractures in type 2 diabetes
    Ann V. Schwartz
    Bone.2016; 82: 2.     CrossRef
  • Efficacy and Safety of Weekly Alendronate Plus Vitamin D35600 IU versus Weekly Alendronate Alone in Korean Osteoporotic Women: 16-Week Randomized Trial
    Kwang Joon Kim, Yong-Ki Min, Jung-Min Koh, Yoon-Sok Chung, Kyoung Min Kim, Dong-Won Byun, In Joo Kim, Mikyung Kim, Sung-Soo Kim, Kyung Wan Min, Ki Ok Han, Hyoung Moo Park, Chan Soo Shin, Sung Hee Choi, Jong Suk Park, Dong Jin Chung, Ji Oh Mok, Hong Sun Ba
    Yonsei Medical Journal.2014; 55(3): 715.     CrossRef
  • Increased Risk of Fracture and Postfracture Adverse Events in Patients With Diabetes: Two Nationwide Population-Based Retrospective Cohort Studies
    Chien-Chang Liao, Chao-Shun Lin, Chun-Chuan Shih, Chun-Chieh Yeh, Yi-Cheng Chang, Yuan-Wen Lee, Ta-Liang Chen
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    Kwang Joon Kim, Kyoung Min Kim, Kyeong Hye Park, Han Seok Choi, Yumie Rhee, Yong Ho Lee, Bong Soo Cha, Myong Jin Kim, Sun Min Oh, J. Keenan Brown, Sung Kil Lim
    Calcified Tissue International.2012; 91(6): 370.     CrossRef

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