Fracture risk by post-cessation weight change in male patients with newly diagnosed type 2 diabetes mellitus

Jina Chung; Sangwoo Park; Sun Jae Park; Hye Jun Kim; Jaewon Kim; Hyeokjong Lee; Seogsong Jeong; Young Jun Park; Kyae Hyung Kim; Hyun-Young Shin; Minjung Han; Kiheon Lee; Sang Min Park

doi:10.1016/j.amjmed.2025.12.014

Fracture risk by post-cessation weight change in male patients with newly diagnosed type 2 diabetes mellitus

Am J Med. 2025 Dec 20:S0002-9343(25)00838-1. doi: 10.1016/j.amjmed.2025.12.014. Online ahead of print.

Authors

Affiliations

¹ Department of Biomedical Science, Seoul National University Graduate School, Seoul, South Korea.
² Department of Biomedical Informatics, Korea University College of Medicine, Seoul, South Korea.
³ Department of Biomedical Science, Seoul National University Graduate School, Seoul, South Korea; Department of Family Medicines, Seoul National University Hospital, Seoul, South Korea.
⁴ Department of Family Medicines, Seoul National University Hospital, Seoul, South Korea; Public Healthcare Center, Seoul National University Hospital, Seoul, South Korea.
⁵ Department of Family Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
⁶ Department of Family Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, South Korea.
⁷ Department of Family Medicines, Seoul National University Hospital, Seoul, South Korea; Department of Family Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea.
⁸ Department of Biomedical Science, Seoul National University Graduate School, Seoul, South Korea; Department of Family Medicines, Seoul National University Hospital, Seoul, South Korea. Electronic address: smpark.snuh@gmail.com.

PMID: 41429231
DOI: 10.1016/j.amjmed.2025.12.014

Abstract

Objective: This study aimed to evaluate the conflicting effects of weight change and smoking cessation on fracture risk in male patients with newly diagnosed type 2 diabetes mellitus (T2DM).

Methods: Using the National Health Insurance Service database, we analyzed 43,564 male patients with newly diagnosed T2DM (2009-2015) who underwent health examinations within ± 2 years of diagnosis. Participants were classified as continual smokers or quitters with no body mass index (BMI) change, BMI gain, or BMI loss. Cox proportional hazards regression was utilized to calculate adjusted hazard ratio (aHR) and 95% confidence interval (CI) for the risk of fracture.

Results: Smoking cessation was not associated with a lower fracture risk compared with continual smoking (aHR, 0.94; 95% CI, 0.81-1.09). Quitters with stable weight had reduced risk (aHR, 0.78; 95% CI, 0.64-0.96); risks were higher with both weight gain and loss, especially loss.

Conclusion: In male patients with newly diagnosed T2DM, smoking cessation did not reduce fracture risk, but weight maintenance after cessation was protective. Weight loss after cessation significantly increased fracture risk, highlighting the need for integrated weight management.