Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026
Diabetes progression and its association with fracture risk in type 2 diabetes.
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Kim Bongsung, Lee Kyu-Na, Han Kyungdo, Kim Mee Kyoung
Аннотация
UNLABELLED: People with type 2 diabetes mellitus (T2DM) accumulate factors that weaken bone. In over two million adults, fracture risk rose stepwise as diabetes progressed, with the steepest increase for hip fractures. A simple progression score using routine clinical data may help flag patients who need earlier bone-protective care.
PURPOSE: Patients with type 2 diabetes mellitus (T2DM) are often exposed to multiple factors contributing to bone fragility-such as poor glycemic control, long duration of exposure to hyperglycemia, and comorbidities. Because these factors often accumulate over time, we examined whether fracture risk increases with diabetes progression.
METHODS: We analyzed data from 2,069,920 patients with T2DM from the Korean National Health Information Database who underwent health examinations in 2015-2016. Patients with a prior history of fractures or who died within one year were excluded. Diabetes progression was scored from 0 to 6 based on the number of oral glucose-lowering drugs, disease duration, insulin use, and presence of chronic kidney disease, cardiovascular disease (CVD), or diabetic retinopathy. Incident fractures were tracked until 2023 using ICD-10 codes.
RESULTS: Over a median follow-up of 6.4 years, 169,595 fractures occurred, including 69,723 vertebral and 23,581 hip fractures. Each component of diabetes progression was independently associated with fracture risk (hazard ratios [HRs] ranging from 1.14 to 1.40). Insulin use (HR, 1.40; 95% confidence interval [CI]: 1.38-1.42) and CVD (HR, 1.26; 95% CI: 1.24-1.28) conferred notably higher risks. Fracture risk increased progressively with higher progression scores (HRs for score 4: 1.60; 95% CI: 1.56-1.64; HRs for score 5: 1.87; 95% CI: 1.78-1.96). The magnitude of increase was more pronounced for hip fractures.
CONCLUSION: The risk of fractures increased incrementally in parallel with diabetes progression, most notably for hip fractures. Diabetes progression metrics may help identify patients at elevated fracture risk.
PURPOSE: Patients with type 2 diabetes mellitus (T2DM) are often exposed to multiple factors contributing to bone fragility-such as poor glycemic control, long duration of exposure to hyperglycemia, and comorbidities. Because these factors often accumulate over time, we examined whether fracture risk increases with diabetes progression.
METHODS: We analyzed data from 2,069,920 patients with T2DM from the Korean National Health Information Database who underwent health examinations in 2015-2016. Patients with a prior history of fractures or who died within one year were excluded. Diabetes progression was scored from 0 to 6 based on the number of oral glucose-lowering drugs, disease duration, insulin use, and presence of chronic kidney disease, cardiovascular disease (CVD), or diabetic retinopathy. Incident fractures were tracked until 2023 using ICD-10 codes.
RESULTS: Over a median follow-up of 6.4 years, 169,595 fractures occurred, including 69,723 vertebral and 23,581 hip fractures. Each component of diabetes progression was independently associated with fracture risk (hazard ratios [HRs] ranging from 1.14 to 1.40). Insulin use (HR, 1.40; 95% confidence interval [CI]: 1.38-1.42) and CVD (HR, 1.26; 95% CI: 1.24-1.28) conferred notably higher risks. Fracture risk increased progressively with higher progression scores (HRs for score 4: 1.60; 95% CI: 1.56-1.64; HRs for score 5: 1.87; 95% CI: 1.78-1.96). The magnitude of increase was more pronounced for hip fractures.
CONCLUSION: The risk of fractures increased incrementally in parallel with diabetes progression, most notably for hip fractures. Diabetes progression metrics may help identify patients at elevated fracture risk.