Patients with Diabetes Remain at Increased Fracture Risk, Despite Declines in Overall Population

An analysis of more than 1.2 million patients who experienced a fracture from 1997-2017 provides insight into contemporary trends in fracture incidence rates based on presence of diabetes.

An analysis of 21 years of data from patients in Denmark is offering insight into the risk of fractures among patients with type 1 and type 2 diabetes as well as their counterparts without diabetes.

Using data from a nationwide registry and database, investigators provide an overview of contemporary trends in fracture risk based on presence and type of diabetes as well as detailing trends in fracture risk over time and risk based on sex.

“Fracture incidence rates decreased between 1997 and 2017 in type 2 diabetics of both sexes and in men with type 1 diabetes. The decline was more prominent in male patients with type 2 diabetes, however fracture incidence rates increased in women with type 1 diabetes—highlighting the need for better interventions and improved fracture prevention measures in this cohort,” said Mohammad Nasser, BSc, a research fellow and PhD candidate at the Steno Diabetes Center at Odense University Hospital, during his presentation.

Presented at the American Society of Bone and Mineral Research 2021 Annual Meeting, the study was designed by Nasser and colleagues from Europe with the goal of understanding how a decline in osteoporotic fractures may have influenced fracture risk among patients with diabetes compared to the general population. The study was designed to examine data related to all patients aged 18 years and older with a fracture from 1997-2017 obtained from within the Danish National Patient Register and the Danish Medicines Agency Register of Medicinal Products Statistics.

From their search, investigators identified 1,238,761 patients with 1,935,636 fractures for inclusion in their study. Of note, 47.7% of patients with type 1 diabetes, 55.6% of patients with type 2 diabetes, and 54.4% of patients without diabetes were female. Specific goals of the analyses were to assess annual incidence rates (IRs) of fractures per 100,000 person-years and the median IR of the first 5 years and the last 5 years to compare changes in fracture rate over time.

Upon analysis, investigators found the IRs of fractures among patients with type 2 diabetes increased from a median of 494.76 per 10,000 person-years between 1997-2002 to 512.83 per 10,000 person-years between 2013-2017. In the same analyses examining patients with type 2 diabetes, results suggested a 17.74% decrease in IRs occurred with a rate of 478.43 per 10,000 person-years from 1997-2002 to 393.57 from 2013-2017, but investigators noted an increasing trend in IRs since 2014 was observed among these patients. In comparison, a decline of 4.71% in the median IRs was observed for patients without diabetes.

In analyses assessing IRs of fracture based on patient sex, results suggest the median IRs declined in all groups from 1997-2001 and 2013-2017, with the largest decline (26.36%) observed among males with type 2 diabetes from 390.52 per 10,000 person-years to 287.57 per 10,000 person-years.

Among female patients, the median IRs increased 12.77% from 599.20 per 10,000 person-years from 1997-2001 to 675.71 per 10,000 person-years from 2013-2017. However, among female patients with type 2 diabetes, the fracture IRs decline by 7.74% during the same periods from 574.42 per 10,000 person-years from 1997-2001 to 529.95 per 10,000 person-years from 2013-2017.

This study, “Comparison of 21-year sex-specific fracture incidence rates between Type 1 and Type 2 diabetics and non-diabetics in Denmark (1997 – 2017),” was presented at ASBMR 2021.