The incidence of fractures at various sites in newly treated patients with type 2 diabetes mellitus
Cindy Sarodnik,
Nicklas H. Rasmussen,
Sandrine P.G. Bours,
Nicolaas C. Schaper,
Peter Vestergaard,
Patrick C. Souverein,
Morten H. Jensen,
Johanna H.M. Driessen,
Joop P.W. van den Bergh
Affiliations
Cindy Sarodnik
NUTRIM Research School, Maastricht University, Maastricht, the Netherlands
Nicklas H. Rasmussen
Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
Sandrine P.G. Bours
Department of Internal Medicine, Maastricht University Medical Centre+, the Netherlands; CAPHRI Research School, Maastricht University, Maastricht, the Netherlands
Nicolaas C. Schaper
Department of Internal Medicine, Maastricht University Medical Centre+, the Netherlands; CAPHRI Research School, Maastricht University, Maastricht, the Netherlands; CARIM Research School, Maastricht University, Maastricht, the Netherlands
Peter Vestergaard
Steno Diabetes Center North Jutland, Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark
Patrick C. Souverein
Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Corresponding author at: Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, PO BOX 80082, 3508 TB Utrecht, the Netherlands.
Morten H. Jensen
Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark
Johanna H.M. Driessen
NUTRIM Research School, Maastricht University, Maastricht, the Netherlands; CARIM Research School, Maastricht University, Maastricht, the Netherlands; Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+, Maastricht, the Netherlands
Joop P.W. van den Bergh
NUTRIM Research School, Maastricht University, Maastricht, the Netherlands; Department of Internal Medicine, Maastricht University Medical Centre+, the Netherlands; Department of Internal Medicine, VieCuri Medical Center, Venlo, the Netherlands
Purpose: In this descriptive study, we examined the incidence of fractures in patients with newly treated type 2 diabetes mellitus (T2D) compared to matched reference population. Methods: Participants from the UK Clinical Practice research datalink (CPRD) GOLD (1987–2017), aged ≥30 years, with a T2D diagnosis code and a first prescription for a non-insulin anti-diabetic drug (n = 124,328) were included. Cases with T2D were matched by year of birth, sex and practice to a reference population (n = 124,328), the mean follow-up was 7.7 years. Crude fracture incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Analyses were stratified by fracture site and sex and additionally adjusted for BMI, smoking status, alcohol use and history of any fracture at index date. Results: The IR of all fractures and major osteoporotic fractures was lower in T2D compared to the reference population (IRR 0.97; 95%CI 0.94–0.99). The IRs were lower for clavicle (IRR 0.67; 0.56–0.80), radius/ulna (IRR 0.81; 0.75–0.86) and vertebral fractures (0.83; 0.75–0.92) and higher for ankle (IRR 1.16; 95%CI 1.06–1.28), foot (1.11; 1.01–1.22), tibia/fibula (1.17; 1.03–1.32) and humerus fractures (1.11; 1.03–1.20). Differences in IRs at various fracture sites between T2D and the reference population were more pronounced in women than in men. In contrast, BMI adjusted IRs for all fractures (IRR 1.07; 1.04–1.10) and most individual fracture sites were significantly higher in T2D, especially in women. Conclusion: The crude incidence of all fractures was marginally lower in patients with newly treated T2D compared to the matched reference population but differed according to fracture site, especially in women. BMI adjusted analyses resulted in higher incidence rates in T2D at almost all fracture sites compared to crude incidence rates and this was more pronounced in women than in men. This implies that BMI may have a protective impact on the crude incidence of fractures, especially in women with newly treated T2D.
