Insights from Secular Trend of Major Osteoporotic Fractures in People with and without Diabetes: 15-Year Population-based Study (2009-2023).

OBJECTIVE

This study aims to evaluate changes in the epidemiology of major osteoporotic fractures (MOF) stratified by diabetes status over 15 years in a population-based cohort.

METHODS

Individuals aged ≥50 years who sustained MOF between 2009 and 2023 identified from territory-wide electronic health database, stratified by diabetes status. Records of HbA1c, hypoglycemic episodes, and osteoporosis screening and treatments were retrieved. Ratios of rates of MOF, osteoporosis screening and treatments between the diabetes and nondiabetes groups were calculated to reflect the disparity between 2 groups. Secular trends were reported in average annual percentage change (AAPC) using joinpoint regression. All rates were age-standardized to the 2021 Hong Kong Census mid-year population.

RESULTS

86 263 hip fractures and 124 268 nonhip fractures were recorded during the study period. Although annual age-standardized incidence of hip fractures decreased, rate ratios between diabetes and nondiabetes remained static at 4.1 for women (AAPC: -0.16%, 95% CI: -0.65 to +0.35, P = .54) and 2.5 for men (AAPC: +0.07%, 95%CI: -0.58 to 0.71, P = .83), suggesting persistent gap of diabetes-specific excess fracture risk. This gap was similarly observed for nonhip fractures. Over the years, age-standardized mean HbA1c improved from 59 mmol/mol (7.5%) to 53 mmol/mol (7%), along with fewer severe hypoglycemic episodes. Prevalence of individuals with screening dual-energy x-ray absorptiometry performed increased, more so in women with diabetes. Anti-osteoporosis medication prescriptions increased in both diabetes and nondiabetes, but increased to a lesser extent in the diabetes population.

CONCLUSION

Diabetes-specific excess fracture risk persisted despite improved glycemic control. Despite increasing efforts of osteoporosis screening in diabetes, this has not translated into more aggressive treatment of bone fragility in diabetes.