Fractures are increased and bisphosphonate use decreased in individuals with insulin-dependent diabetes: a 10 year cohort study

BMC Musculoskeletal Disorders

Lehana Thabane²  Jinhui Ma²  Jonathan D Adachi³  Alexandra Papaioannou³  Lisa-Ann Fraser¹ 

[1] Division of Endocrinology and Metabolism, St. Joseph’s Hospital, 268 Grosvenor Street, London N6A 4 V2 Ontario, Canada;Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada;Department of Medicine, McMaster University, Hamilton, Ontario, Canada

关键词: Osteoporosis;    Treatment;    Care gap;    Insulin;    Diabetes;    Fracture;   

Others  :  1125566
DOI  :  10.1186/1471-2474-15-201

 received in 2013-07-17, accepted in 2014-06-05,  发布年份 2014

【 摘 要 】

Background

Individuals with diabetes have been found previously to be at increased risk of non-traumatic fracture. However, it is unclear if these individuals are being identified and treated for osteoporosis.

Methods

7753 Canadians over 50 years of age were followed prospectively for 10 years. 606/7753 (7.8%) of had diabetes; 98 were insulin-dependent and 508 were not. Using a cox proportional hazards model, we assessed the association between diabetes status and incident non-traumatic fracture. Using logistic regression we identified factors associated with bisphosphonate use over the 10 year period of study.

Results

Mean (SD) age of participants was 66.7(9.4) years and 72% were female. Those with diabetes had higher BMD T-scores at baseline, with a mean (SD) femoral neck T-Score of -0.97 (1.06), compared to -1.24 (0.99) in the general cohort. The adjusted hazard ratio (HR) for incident non-traumatic fracture in individuals with insulin-dependent diabetes over the 10 year study period was 2.50 (95% confidence interval [CI] 1.60, 3.90; p < 0.001). Despite this increased fracture rate, individuals with diabetes (insulin-dependent or non-insulin-dependent) were less likely to be on bisphosphonate therapy at any point over 10 years of prospective follow up compared to other CaMos subjects (odds ratio [OR]: 0.59; 95% CI 0.46-0.75, p < 0.001).

Conclusions

Despite the increased risk of non-traumatic fracture associated with insulin-dependent diabetes, we that found individuals with diabetes are less likely to be treated with a bisphosphonate than those without diabetes. These findings point to a possible care gap in the treatment of non-traumatic fractures in individuals with diabetes in Canada.

【 授权许可】

   
2014 Fraser et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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