Fracture risk in diabetic elderly men: The MrOS study

Nicola Napoli, Elsa S. Strotmeyer, Kristine E. Ensrud, Deborah E. Sellmeyer, Douglas C. Bauer, Andrew R. Hoffman, Thuy Tien L. Dam, Elizabeth Barrett-Connor, Lisa Palermo, Eric S. Orwoll, Steven R. Cummings, Dennis M. Black, Ann V. Schwartz

Research output: Contribution to journalArticlepeer-review

137 Scopus citations

Abstract

Aims/hypothesis Diabetes mellitus is associated with increased fracture risk in women but few studies are available in men. To evaluate the relationship between diabetes and prospective non-vertebral fractures in elderly men, we used data from the Osteoporotic Fractures in Men (MrOS) study. Methods The MrOS enrolled 5,994 men (aged ≥65 years). Diabetes (ascertained by self-report, the use of medication for diabetes or an elevated fasting glucose level) was reported in 881 individuals, 80 of whom were using insulin. Hip and spine bone mineral density (BMD) was measured using dual x-ray absorptiometry (DXA). After recruitment, the men were followed for incident non-vertebral fractures using a triannual (3 yearly) questionnaire for an average of 9.1 (SD 2.7) years. The Cox proportional hazards model was used to assess the incident risk of fractures. Results In models adjusted for age, race, clinic site and total hip BMD, the risk of non-vertebral fracture was higher in men with diabetes compared with normoglycaemic men (HR 1.30, 95%CI 1.09, 1.54) and was elevated inmen using insulin (HR 2.46, 95% CI 1.69, 3.59). Men with impaired fasting glucose did not have a higher risk of fracture compared with normoglycaemic men (HR 1.04, 95% CI 0.89, 1.21). After multivariable adjustment, the risk of non-vertebral fracture remained higher only among men with diabetes who were using insulin (HR 1.74, 95% CI 1.13, 2.69). Conclusions/interpretation Men with diabetes who are using insulin have an increased risk of non-vertebral fracture for a given age and BMD.

Original languageEnglish (US)
Pages (from-to)2057-2065
Number of pages9
JournalDiabetologia
Volume57
Issue number10
DOIs
StatePublished - Oct 2014

Bibliographical note

Funding Information:
Funding The Osteoporotic Fractures in Men (MrOS) study is supported by National Institutes of Health funding. The following institutes provide support: the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), the National Institute on Aging (NIA), the National Center for Research Resources (NCRR) and NIH Roadmap for Medical Research under the following grant numbers: U01 AR45580, U01 AR45614, U01 AR45632, U01 AR45647, U01 AR45654, U01 AR45583, U01AG18197, U01-AG027810, and UL1 RR024140. Glucose measurements were supported by a grant from the American ADA (1-04-JF-46, Strotmeyer ES).

Publisher Copyright:
© Springer-Verlag Berlin Heidelberg 2014.

Keywords

  • Bone
  • Diabetes
  • Fractures
  • Impaired fasting glucose
  • Insulin
  • Osteoporosis

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