RT Journal Article
SR Electronic
T1 Vertebral Fractures in Individuals With Type 2 Diabetes: More Than Skeletal Complications Alone
JF Diabetes Care
JO Diabetes Care
FD American Diabetes Association
SP dc190925
DO 10.2337/dc19-0925
A1 Koromani, Fjorda
A1 Oei, Ling
A1 Shevroja, Enisa
A1 Trajanoska, Katerina
A1 Schoufour, Josje
A1 Muka, Taulant
A1 Franco, Oscar H.
A1 Ikram, M. Arfan
A1 Zillikens, M. Carola
A1 Uitterlinden, André G.
A1 Krestin, Gabriel P.
A1 Anastassiades, Tassos
A1 Josse, Robert
A1 Kaiser, Stephanie M.
A1 Goltzman, David
A1 Lentle, Brian C.
A1 Prior, Jerilynn C.
A1 Leslie, William D.
A1 McCloskey, Eugene
A1 Lamy, Olivier
A1 Hans, Didier
A1 Oei, Edwin H.
A1 Rivadeneira, Fernando
YR 2019
UL http://care.diabetesjournals.org/content/early/2019/10/25/dc19-0925.abstract
AB OBJECTIVE We aimed to assess whether individuals with type 2 diabetes (T2D) have increased risk of vertebral fractures (VFs) and to estimate nonvertebral fracture and mortality risk among individuals with both prevalent T2D and VFs.RESEARCH DESIGN AND METHODS A systematic PubMed search was performed to identify studies that investigated the relationship between T2D and VFs. Cohorts providing individual-participant data (IPD) were also included. Estimates from published summary data and IPD cohorts were pooled in a random-effects meta-analysis. Multivariate Cox-regression models were used to estimate nonvertebral fracture and mortality risk among individuals with T2D and VFs.RESULTS Across 15 studies comprising 852,705 men and women, individuals with T2D had lower risk of prevalent (odds ratio [OR] 0.84 [95% CI 0.74–0.95]; I2 = 0.0%; Phet = 0.54) but increased risk of incident VFs (OR 1.35 [95% CI 1.27–1.44]; I2 = 0.6%; Phet = 0.43). In the IPD cohorts (N = 19,820), risk of nonvertebral fractures was higher in those with both T2D and VFs compared with those without T2D or VFs (hazard ratio [HR] 2.42 [95% CI 1.86–3.15]), with VFs (HR 1.73 [95% CI 1.32–2.27]), or T2D (HR 1.94 [95% CI 1.46–2.59]) alone. Individuals with both T2D and VFs had increased mortality compared with individuals without T2D and VFs (HR 2.11 [95% CI 1.72–2.59]) or with VFs alone (HR 1.84 [95% CI 1.49–2.28]) and borderline increased compared with individuals with T2D alone (HR 1.23 [95% CI 0.99–1.52]).CONCLUSIONS Based on our findings, individuals with T2D should be systematically assessed for presence of VFs, and, as in individuals without T2D, their presence constitutes an indication to start osteoporosis treatment for the prevention of future fractures.