Diabetes and Risk of Fracture
The Blue Mountains Eye Study
- Rebecca Q. Ivers, B OPTOM, MPH, PHD12,
- Robert G. Cumming, MB BS, MPH, PHD2,
- Paul Mitchell, MD, PHD, FRACO3 and
- Anthony J. Peduto, MB BS, FRANZCR4
- 1Institute for International Health
- 2Department of Public Health and Community Medicine, the University of Sydney
- 3Department of Ophthalmology, the University of Sydney, Westmead Hospital
- 4Department of Radiology, Westmead Hospital
Abstract
OBJECTIVE—To examine associations between measures of diabetes and risk of fracture in a population-based sample of older Australians.
RESEARCH DESIGN AND METHODS—This was a prospective study of 3,654 subjects aged 49 years and older who were residents in the Blue Mountains, west of Sydney, Australia. At baseline, subjects were asked questions about history and treatment of diabetes, and fasting blood samples were taken. Photographs were taken of the retina and lens to grade retinopathy and cataract. Details of fractures (excluding rib and vertebral fractures) were collected by a combination of self-report and medical record searches; all fractures were radiologically confirmed.
RESULTS—After 2 years of follow-up, we found that several diabetes-related factors were significantly associated (in multivariate models) with increased risk of all fractures combined, including presence of diabetic retinopathy (adjusted RR 5.4, 95% CI 2.7–10.8), diabetes duration ≥10 years (3.3, 1.3–8.2), cortical cataract involving ≥25% of the lens area (2.5, 1.3–4.7), and insulin treatment (5.9, 2.6–13.5). The proximal humerus was the only individual fracture site associated with diabetes. Diabetic retinopathy (10.3, 2.2–48.0), diabetes duration (for ≥10 years duration; 11.4, 2.4–54.2), and insulin treatment (18.8, 4.0–88.7) were all associated with proximal humerus fracture.
CONCLUSIONS—These data suggest a significantly increased risk of fracture associated with diabetic retinopathy, advanced cortical cataract, longer diabetes duration, and insulin treatment. However, there are some shortcomings in this study that may limit these findings.
Footnotes
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Address correspondence and reprint requests to Rebecca Q. Ivers, Institute for International Health, P.O. Box 576, Newtown, NSW, 2042, Australia. E-mail: rivers{at}iih.usyd.edu.au.
Received for publication 31 August 2000 and accepted in revised form 26 March 2001.
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