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Diabetes Care Publish Ahead of Print published online ahead of print October 18, 2007
DOI: 10.2337/dc07-1072

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Original Research

Increased risks of hip fracture in diabetic patients of Taiwan: A population-based study

Hua-Fen Chen, MD, MSc1, Ching-An Ho, MD2 and Chung-Yi Li, PhD3

1 Department of Endocrinology, Far-Eastern Memorial Hospital, Taipei Hsien, Taiwan
2 Department of Orthopedic Surgery, Catholic Mercy Hospital, Hsinchu Hsien, Taiwan
3 Department of Health Care Management, National Taipei College of Nursing, Taipei, Taiwan

cyli{at}ntcn.edu.tw

cyli{at}ntcn.edu.tw

ABSTRACT

Objective: Using Taiwan's National Health Insurance claim data, we evaluated the age-, sex- and urbanization-specific incidence density and relative risks of hip fracture in the diabetic population.

Research Design and Methods: Diabetic patients (n=500,868) and the age- and sex-matched control group (n=500,248) were linked to the inpatient claims (1997–2002) to identify hospitalizations of non-transport accident hip fracture. Person-year approach with Poisson assumption and Kaplan-Meier analysis were used to estimate the incidence and the cumulative event rates. We also assessed the age-, sex- and urbanization-specific relative risks of hip fracture in relation to diabetes with Cox proportional hazard regression model.

Results: The overall incidence of hip fracture for diabetic men and women respectively were 3.01 and 6.75/1,000 person-years, which were higher than those of control men and women. There were significant interaction of diabetes and age and diabetes and urbanization statuses. Hazard ratios (HRs) of diabetic patients aged 35-44 (men=2.45; 95% CI 1.65-3.64; women=3.19; 95% CI 1.39–7.33) were higher than those of aged 55-64 (men=1.90; women=2.81), but in diabetic men aged >74 and diabetic women aged >84, the HRs were compared to null statistically (HR: 0.98 and 0.91, respectively). Diabetic patients living in rural areas tended to experience higher HRs of hip fracture.

Conclusions: In Taiwan, diabetes increased the risk of hip fracture in both genders in all age groups except in diabetic men aged >74 and diabetic women aged >84. Higher HRs of hip fracture were disproportionately observed in younger diabetic patients and in those living in rural areas.


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