The Risk of Hip Fractures in Older Individuals With Diabetes

A population-based study

  1. Lorraine L. Lipscombe, MD, MSC123,
  2. Sophie A. Jamal, MD, PHD245,
  3. Gillian L. Booth, MD, MSC1245 and
  4. Gillian A. Hawker, MD, MSC1235
  1. 1The Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
  2. 2Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  3. 3Women's College Hospital, Toronto, Ontario, Canada
  4. 4Saint Michael's Hospital, Toronto, Ontario, Canada
  5. 5Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
  1. Address correspondence and reprint requests to Dr. Lorraine L. Lipscombe, Institute for Clinical Evaluative Sciences, 2075 Bayview Ave., Toronto, Ontario, M4N 3M5 Canada. E-mail: lorraine.lipscombe{at}


OBJECTIVE—Compared with men and women without diabetes, individuals with type 2 diabetes have higher bone mineral density (BMD). However, they may still be at increased risk for hip fractures. Using population-based Ontario health care data, we compared the risk of hip fractures among men and women with and without diabetes.

RESEARCH DESIGN AND METHODS—Using a retrospective cohort design, we identified Ontario residents aged ≥66 years with diabetes from a validated registry from 1994 to 1995 (n = 197,412) and followed them for their first hip fracture until 31 March 2003 (mean 6.1-year follow-up). Hip fracture rates were compared with those of age-matched Ontario residents without diabetes (n = 401,400), and results were stratified by sex and adjusted for age and other covariates.

RESULTS—Compared with individuals without diabetes, individuals with diabetes had greater comorbidity, were less likely to have had a BMD test, and were more likely to be taking medications that increase risk of falling and decrease BMD. After adjusting for these differences and age, we found that diabetes increased fracture risk in both men (hazard ratio 1.18 [95% CI 1.12–1.24], P < 0.0001) and women (1.11 [1.08–1.15], P < 0.0001).

CONCLUSIONS—Men and women with diabetes have a higher risk of hip fractures compared with individuals without diabetes. Further research to elucidate the mechanisms underlying this increased risk of fracture is needed, as well as increased attention to fracture prevention strategies in patients with diabetes.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C Section 1734 solely to indicate this fact.

    • Accepted December 29, 2006.
    • Received September 5, 2006.
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