Guowei Li1,2,3, Jerilynn C Prior4, William D Leslie5, Lehana Thabane2,3, Alexandra Papaioannou2,6, Robert G Josse7, Stephanie M Kaiser8, Christopher S Kovacs9, Tassos Anastassiades10, Tanveer Towheed10, K Shawn Davison11, Mitchell Levine2,3,6, David Goltzman12, Jonathan D Adachi. 1. Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China lig28@mcmaster.ca. 2. Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada. 3. St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada. 4. Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada. 5. Departments of Medicine and Radiology, University of Manitoba, Winnipeg, Manitoba, Canada. 6. Department of Medicine, McMaster University, Hamilton, Ontario, Canada. 7. Department of Medicine, University of Toronto, Toronto, Ontario, Canada. 8. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada. 9. Faculty of Medicine, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada. 10. Department of Medicine, Queen's University, Kingston, Ontario, Canada. 11. Saskatoon Osteoporosis and CaMos Centre, Saskatoon, Saskatchewan, Canada. 12. Department of Medicine, McGill University, Montréal, Québec, Canada.
Abstract
OBJECTIVE: We aimed to explore whether frailty was associated with fracture risk and whether frailty could modify the propensity of type 2 diabetes toward increased risk of fractures. RESEARCH DESIGN AND METHODS: Data were from a prospective cohort study. Our primary outcome was time to the first incident clinical fragility fracture; secondary outcomes included time to hip fracture and to clinical spine fracture. Frailty status was measured by a Frailty Index (FI) of deficit accumulation. The Cox model incorporating an interaction term (frailty × diabetes) was used for analyses. RESULTS: The analysis included 3,149 (70% women) participants; 138 (60% women) had diabetes. Higher bone mineral density and FI were observed in participants with diabetes compared with control subjects. A significant relationship between the FI and the risk of incident fragility fractures was found, with a hazard ratio (HR) of 1.02 (95% CI 1.01-1.03) and 1.19 (95% CI 1.10-1.33) for per-0.01 and per-0.10 FI increase, respectively. The interaction was also statistically significant (P = 0.018). The HR for per-0.1 increase in the FI was 1.33 for participants with diabetes and 1.19 for those without diabetes if combining the estimate for the FI itself with the estimate from the interaction term. No evidence of interaction between frailty and diabetes was found for risk of hip and clinical spine fractures. CONCLUSIONS: Participants with type 2 diabetes were significantly frailer than individuals without diabetes. Frailty increases the risk of fragility fracture and enhances the effect of diabetes on fragility fractures. Particular attention should be paid to diabetes as a risk factor for fragility fractures in those who are frail.
OBJECTIVE: We aimed to explore whether frailty was associated with fracture risk and whether frailty could modify the propensity of type 2 diabetes toward increased risk of fractures. RESEARCH DESIGN AND METHODS: Data were from a prospective cohort study. Our primary outcome was time to the first incident clinical fragility fracture; secondary outcomes included time to hip fracture and to clinical spine fracture. Frailty status was measured by a Frailty Index (FI) of deficit accumulation. The Cox model incorporating an interaction term (frailty × diabetes) was used for analyses. RESULTS: The analysis included 3,149 (70% women) participants; 138 (60% women) had diabetes. Higher bone mineral density and FI were observed in participants with diabetes compared with control subjects. A significant relationship between the FI and the risk of incident fragility fractures was found, with a hazard ratio (HR) of 1.02 (95% CI 1.01-1.03) and 1.19 (95% CI 1.10-1.33) for per-0.01 and per-0.10 FI increase, respectively. The interaction was also statistically significant (P = 0.018). The HR for per-0.1 increase in the FI was 1.33 for participants with diabetes and 1.19 for those without diabetes if combining the estimate for the FI itself with the estimate from the interaction term. No evidence of interaction between frailty and diabetes was found for risk of hip and clinical spine fractures. CONCLUSIONS:Participants with type 2 diabetes were significantly frailer than individuals without diabetes. Frailty increases the risk of fragility fracture and enhances the effect of diabetes on fragility fractures. Particular attention should be paid to diabetes as a risk factor for fragility fractures in those who are frail.
Authors: Bowen Wang; Zehai Wang; Atharva A Poundarik; Mohammed J Zaki; Richard S Bockman; Benjamin S Glicksberg; Girish N Nadkarni; Deepak Vashishth Journal: J Clin Endocrinol Metab Date: 2022-03-24 Impact factor: 5.958
Authors: Antimo Moretti; Angela Palomba; Francesca Gimigliano; Marco Paoletta; Sara Liguori; Francesco Zanfardino; Giuseppe Toro; Giovanni Iolascon Journal: Orthop Rev (Pavia) Date: 2022-10-13
Authors: Fjorda Koromani; Ling Oei; Enisa Shevroja; Katerina Trajanoska; Josje Schoufour; Taulant Muka; Oscar H Franco; M Arfan Ikram; M Carola Zillikens; André G Uitterlinden; Gabriel P Krestin; Tassos Anastassiades; Robert Josse; Stephanie M Kaiser; David Goltzman; Brian C Lentle; Jerilynn C Prior; William D Leslie; Eugene McCloskey; Olivier Lamy; Didier Hans; Edwin H Oei; Fernando Rivadeneira Journal: Diabetes Care Date: 2019-10-28 Impact factor: 19.112