The diabetes-fracture association in women with type 1 and type 2 diabetes is partially mediated by falls: a 15-year longitudinal study

doi:10.1007/s00198-020-05771-9

Observational Study

. 2021 Jun;32(6):1175-1184.

doi: 10.1007/s00198-020-05771-9. Epub 2021 Jan 7.

The diabetes-fracture association in women with type 1 and type 2 diabetes is partially mediated by falls: a 15-year longitudinal study

E P Thong^{1

2}, F Milat^{2

3}, J C Enticott², A E Joham^{1

2}, P R Ebeling^{1

4}, G D Mishra⁵, H J Teede^{6

7}

Affiliations

¹ Departments of Endocrinology & Diabetes, Monash Health, Clayton, Victoria, Australia.
² Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia.
³ Hudson Institute of Medical Research, Clayton, Victoria, Australia.
⁴ Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
⁵ Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, St Lucia, Queensland, Australia.
⁶ Departments of Endocrinology & Diabetes, Monash Health, Clayton, Victoria, Australia. helena.teede@monash.edu.
⁷ Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia. helena.teede@monash.edu.

PMID: 33411006
DOI: 10.1007/s00198-020-05771-9

Observational Study

The diabetes-fracture association in women with type 1 and type 2 diabetes is partially mediated by falls: a 15-year longitudinal study

E P Thong et al. Osteoporos Int. 2021 Jun.

. 2021 Jun;32(6):1175-1184.

doi: 10.1007/s00198-020-05771-9. Epub 2021 Jan 7.

Authors

E P Thong^{1

2}, F Milat^{2

3}, J C Enticott², A E Joham^{1

2}, P R Ebeling^{1

4}, G D Mishra⁵, H J Teede^{6

7}

Affiliations

¹ Departments of Endocrinology & Diabetes, Monash Health, Clayton, Victoria, Australia.
² Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia.
³ Hudson Institute of Medical Research, Clayton, Victoria, Australia.
⁴ Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia.
⁵ Centre for Longitudinal and Life Course Research, School of Public Health, University of Queensland, St Lucia, Queensland, Australia.
⁶ Departments of Endocrinology & Diabetes, Monash Health, Clayton, Victoria, Australia. helena.teede@monash.edu.
⁷ Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia. helena.teede@monash.edu.

PMID: 33411006
DOI: 10.1007/s00198-020-05771-9

Abstract

This study evaluated mediators of fracture risk in postmenopausal women with type 1 (T1D) and type 2 diabetes (T2D), over a 15-year follow-up period. This study provides evidence that the increased fracture risk in women with T1D or T2D is partially explained by falls. Furthermore, a shorter reproductive lifespan in women with T1D contributes modestly to fracture risk in this cohort.

Purpose: Skeletal fragility is associated with diabetes mellitus, while limited estrogen exposure during the reproductive years also predisposes to lower bone mass and higher fracture risk. We aimed to determine osteoporosis diagnosis, fall and fracture rates in women with type 1 (T1D) and type 2 (T2D) diabetes mellitus, and explore mediators of the diabetes-fracture relationship.

Methods: Prospective observational data drawn from the Australian Longitudinal Study in Women's Health (ALSWH) from 1996 to 2010. Women were randomly selected from the national health insurance database. Standardized data collection occurred at six survey time points, with main outcome measures being self-reported osteoporosis, incident fracture, falls, and reproductive lifespan. Mediation analyses were performed to elucidate relevant intermediaries in the diabetes-fracture relationship.

Results: Exactly 11,313 women were included at baseline (T1D, n = 107; T2D, n = 333; controls, n = 10,873). A total of 885 new cases of osteoporosis and 1099 incident fractures were reported over 15 years. Women with T1D or T2D reported more falls and fall-related injuries; additionally, women with T1D had a shorter reproductive lifespan. While fracture risk was increased in women with diabetes (T1D: OR 2.28, 95% CI 1.53-3.40; T2D: OR 2.40, 95% CI 1.90-3.03), compared with controls, adjustment for falls attenuated the risk of fracture by 10% and 6% in T1D and T2D, respectively. In women with T1D, reproductive lifespan modestly attenuated fracture risk by 4%.

Conclusion: Women with T1D and T2D have an increased risk of fracture, which may be partially explained by increased falls, and to a lesser extent by shorter reproductive lifespan, in T1D.

Keywords: Bone health; Menopause; Type 1 diabetes; Type 2 diabetes.

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References

1. International Diabetes Federation (2019) IDF Diabetes Atlas, 9th edn. Brussels, Belgium. Available at: https://www.diabetesatlas.org . Accessed 19 Oct 2019
1. Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporos Int 18:427–444 - PubMed
1. Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505 - PubMed
1. Shah VN, Shah CS, Snell-Bergeon JK (2015) Type 1 diabetes and risk of fracture: meta-analysis and review of the literature. Diabet Med 32:1134–1142 - PubMed - PMC
1. Weber DR, Haynes K, Leonard MB, Willi SM, Denburg MR (2015) Type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN). Diabetes Care 38:1913–1920 - PubMed - PMC

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[1] International Diabetes Federation (2019) IDF Diabetes Atlas, 9th edn. Brussels, Belgium. Available at: https://www.diabetesatlas.org . Accessed 19 Oct 2019

[2] International Diabetes Federation (2019) IDF Diabetes Atlas, 9th edn. Brussels, Belgium. Available at: https://www.diabetesatlas.org . Accessed 19 Oct 2019

[3] Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporos Int 18:427–444 - PubMed

[4] Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporos Int 18:427–444 - PubMed

[5] Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505 - PubMed

[6] Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505 - PubMed

[7] Shah VN, Shah CS, Snell-Bergeon JK (2015) Type 1 diabetes and risk of fracture: meta-analysis and review of the literature. Diabet Med 32:1134–1142 - PubMed - PMC

[8] Shah VN, Shah CS, Snell-Bergeon JK (2015) Type 1 diabetes and risk of fracture: meta-analysis and review of the literature. Diabet Med 32:1134–1142 - PubMed - PMC

[9] Weber DR, Haynes K, Leonard MB, Willi SM, Denburg MR (2015) Type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN). Diabetes Care 38:1913–1920 - PubMed - PMC

[10] Weber DR, Haynes K, Leonard MB, Willi SM, Denburg MR (2015) Type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN). Diabetes Care 38:1913–1920 - PubMed - PMC

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The diabetes-fracture association in women with type 1 and type 2 diabetes is partially mediated by falls: a 15-year longitudinal study

Affiliations

The diabetes-fracture association in women with type 1 and type 2 diabetes is partially mediated by falls: a 15-year longitudinal study

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