Frontiers in Endocrinology (Apr 2015)

Predictors of mortality subsequent to a fracture in diabetes mellitus patients

  • Jakob eStarup-Linde,
  • Sidse eWestberg-Rasmussen,
  • Søren eGregersen,
  • Peter eVestergaard,
  • Peter eVestergaard

DOI
https://doi.org/10.3389/fendo.2015.00046
Journal volume & issue
Vol. 6

Abstract

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Background: Type-1 and type-2 Diabetes Mellitus (DM) is associated with an increased fracture risk and possibly an increased risk of death following a fracture.Aim: To investigate the association between diabetes related drugs and mortality following a fracture. Methods: A nested case-control study was conducted. Cases were patients with DM who died following a fracture; controls were DM patients not dying after a fracture. We identified DM patients using the Danish National Hospital Discharge Register (1977-2011) and included information on date of DM diagnosis, date of fracture and comorbidities. From the Danish Cause of Death Register the date of death was collected (2008-2011). From the Central Region of Jutland, Denmark, medication use was collected (2008-2011). Analysis was performed by unconditional logistic regression.Results: 2,621 diabetes patients with a fracture following the diabetes diagnosis and with information on medication use were included. Of these 229 died. In a multivariate analysis, statin use (n= 1,106 (42%) statin users, odds ratio (OR) = 0.60, 95 % confidence interval, p=0.012) decreased the risk of dying subsequent to a fracture. Male gender (OR=1.57, p=0.005), increasing age (OR=1.08, p<0.001), a diagnosis of retinopathy (OR=2.12, p=0.008), heart failure (OR= 1.68, p=0.004) and use of glucocorticoids (OR=2.22, p=0.001) were associated with an increased risk of death. None of the antidiabetics; biguanides, glucagon-like receptor agonists, β-cell stimulants, glitazones, and insulin were associated with mortality.Conclusion: Co-morbidity reflected by late onset complications, heart failure and glucocorticoid use was associated with an increased risk of mortality subsequent to a fracture. Statin use may reduce mortality subsequent to a fracture in diabetes patients. Clinical trials are needed to determine whether diabetes patients with a fracture should initiate statin treatment.

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