Category: Diabetes/Prediabetes/Hypoglycemia

Monitor: 23

23 - DIABETES INCREASES SHORT-TERM BUT NOT LONG-TERM RISK OF FRACTURE: A COMMUNITY-BASED STUDY

Thursday, Apr 25
11:00 AM – 11:30 AM

Objective :

Older adults with type 2 diabetes (T2D) have increased risk of fracture compared to those who do not have T2D (no-T2D), yet T2D tend to have normal to high bone mineral density (BMD).  Little is known about “imminent” or short-term risk of fracture in T2D, as these individuals are most in need of treatment.  Therefore, we evaluated the association of T2D with fracture incidence over short- and long-term risk of fracture in women and men in a community-based cohort. 


Methods :

Participants were members of the Framingham Original and Offspring Cohorts who attended an osteoporosis study visit ~1990 (baseline).  T2D was defined as fasting plasma glucose > 125 mg/dL or on T2D treatment.  Incident fractures excluded finger, toe, skull, face, and pathologic fractures.  We used repeated measures analyses to estimate hazard ratios (HRs, 95% CIs) for the association between T2D, T2D medication use, and T2D duration and incident fracture, adjusted for age, sex, height, and weight, in women and men.  Follow-up time was calculated from baseline to the first of:  fracture, death, loss (<1%) or end of follow-up in 2009. We estimated HRs for the full follow-up time and restricting to 1 and 2 years. 


Results :

Participants included 2,105 women and 1,130 men (mean age 67 ± 10 yr).  Median follow-up time was 9 yr (IQR 6 to 11).  Prevalence of T2D was 9% (7% women, 13% men); of these, 63% women with T2D and 51% men with T2D were on any T2D medication.  Mean duration of T2D was 8 ± 7 yr.  Cumulative incidence of fracture was 37% in T2D vs 30% in no-T2D in women, and 11% vs 16%, respectively, in men.  T2D was associated with 1 yr fracture risk in women (HR=2.23; 1.13-4.42) but not men.  In the total group, longer duration of T2D (HR=1.28; CI=1.03-1.59, per 5yr) and any T2D medication use (HR=1.70; CI=1.01-2.85) increased 2-yr fracture risk.  Associations between T2D and long-term incidence of fracture were not significant. 


Discussion :

In this community-based population, we found that T2D, as well as longer T2D duration and T2D medication use, were associated with short-term but not long-term risk of fracture.  Competing risk of death may have resulted in our underestimating associations with long-term fracture.  Associations were more apparent in women than men, however, relatively small numbers of men may have reduced the ability to detect associations. 


Conclusion :

T2D have increased imminent risk of fracture, and thus clinical intervention may be particularly effective for fracture reduction in older adults with T2D.  Evaluation of risk factors for short- vs long-term fracture risk may help to improve risk stratification in T2D. 

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Alyssa Dufour

Instructor of Medicine
Marcus Institute for Aging Research, Hebrew SeniorLife & Harvard Medical School, Boston, MA

Alyssa B. Dufour, PhD is a Biostatistician and Assistant Scientist II at the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Instructor in Medicine at Harvard Medical School. She received her PhD in Biostatistics from Boston University Graduate School. Her methodological expertise is based in cluster analysis of unstable longitudinal patterns of disease progression. Her clinical interests include foot health and musculoskeletal and rheumatic disease in older adults.

Setareh Williams

Senior Director, HEOR
Radius Health, Inc., Waltham, MA

Setareh Williams is currently the head of Health Economics and Outcomes Research (HEOR) at Radius Health, Inc. She is responsible for planning, execution and communication of HEOR studies. She earned her PhD and Masters in Chronic Disease Epidemiology from Yale University and her BS in Biological Sciences and French Literature from University of California at Los Angeles. Setareh has 20+ years of industry experience supporting multiple product launches and in-line brands. Prior to joining Radius, Setareh worked at Novartis, AstraZeneca, and Pfizer and has published extensively in epidemiology, outcomes research, and comparative effectiveness. In her most recent role she was responsible for developing a Global Integrated Real-world Evidence Plan to address needs of payers, prescribers, and patients.

Richard Weiss

Executive Medical Director
Radius Health, Inc., Waltham, MA

Dr. Weiss is a long-term member of AACE for over 20 years. He practiced clinical endocrinology for 24 years prior to entering industry in 2013. Currently, Dr. Weiss serves as Executive Director of Medical Affairs at Radius Health.

Elizabeth Samelson

Associate Scientist
Marcus Institute for Aging Research, Hebrew SeniorLife & Harvard Medical School, Boston, MA

Elizabeth (Lisa) Samelson, PhD, is Associate Scientist at the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Assistant Professor at Harvard Medical School. Her major areas of research include the epidemiology of osteoporosis and related fractures, diabetes and skeletal fragility, vascular underpinnings of osteoporosis, and spinal degeneration. Dr. Samelson is Principal Investigator of the Framingham Hyperkyphosis Study, funded by the National Institutes of Health, and has conducted numerous investigations in collaboration with the Framingham Study to identify risk factors for declines in musculoskeletal health with aging. Dr. Samelson directs the Advanced Aging Research Training Seminar (AARTSS) in the Harvard Translational Research in Aging Training Program, mentoring trainees and early-stage investigators in methods of aging research, and she is an Advisor in the Harvard Catalyst Grant Review and Support Program (GRASP), where she guides junior investigators in project management and grant-writing. Dr. Samelson received a PhD in Epidemiology from Columbia University and completed a post-doctoral fellowship in musculoskeletal epidemiology at Boston University School of Medicine.