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Publications

Journal Article Ahead of print

PubMed: 42507670 DOI: 10.2337/dc26-0612

Fracture Risk Is Increased in Type 1 Diabetes and Is the Highest in Individuals With Diabetic Kidney Disease.

Diabetes Care

Authors: Maija Feodoroff, Sari Mäkimattila, Lena M Thorn, Per-Henrik Groop, Niina Sandholm, Valma Harjutsalo

Affiliations

  • Folkhälsan Research Centre, Helsinki, Finland.
  • Department of Nephrology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
  • Department of Endocrinology and Diabetes, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
  • Department of Diabetes, Central Clinical School, Monash University, Melbourne, Victoria, Australia.
  • Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia.

Abstract

OBJECTIVE

To quantify the excess risk of any fractures, major osteoporotic fractures (MOF), and hip fractures in type 1 diabetes (T1D) by age, stages of diabetic kidney disease (DKD), and sex, and to evaluate risk factors for fractures.

RESEARCH DESIGN AND METHODS

The study included 5,035 individuals from the Finnish Diabetic Nephropathy Study (FinnDiane) and 12,286 control individuals without diabetes. We assessed the standardized incidence ratios (SIRs) for fractures in individuals with T1D compared with control individuals. Cox regression analyses were conducted in individuals with T1D to identify potential factors associated with fractures.

RESULTS

SIR for any fracture was 2.15 (95% CI 2.06-2.25), 2.60 (2.41-2.79) for MOF, and 5.24 (4.55-6.02) for hip fracture. SIR of hip fracture was the highest in those aged 40-49 years, 8.13 (5.75-11.2). All age-groups after 10-19 years had excess fracture risk. The SIR of any fracture increased with the DKD stages; 2.54 (2.36-2.72) in individuals without albuminuria, 3.47 (3.02-3.98), in those with moderate albuminuria, 3.73 (3.27-4.25) in those with severe albuminuria, and 5.08 (4.16-6.16) in those with kidney failure. SIRs for MOF were 2.62 (2.34-2.93) in those without albuminuria, 3.84 (3.10-4.71) in those with moderate albuminuria, 4.53 (3.72-5.48) in those with severe albuminuria, and 5.85 (4.38-7.68) in those with kidney failure. Hypoglycemic coma episodes (hazard ratio 1.04 [1.01-1.07]) and HbA1c (1.11 [1.06-1.15]) were associated with risk of any fracture, and episodes of diabetic ketoacidosis were associated with risk of MOF (1.18 [1.11-1.25]) in T1D.

CONCLUSIONS

Findings suggest that fracture risk assessment may need to be considered earlier than currently recommended, especially among individuals with DKD.

MeSH

Diabetes Mellitus, Kidney Diseases, Diabetic Nephropathies, Albuminuria, Kidney, Diabetes Mellitus, Type 1