Fracture risk and treatment thresholds in patients with diabetes

IF 4.7 2区医学 Q1 ENDOCRINOLOGY & METABOLISM

Diabetes & metabolism Pub Date : 2026-03-01 Epub Date: 2026-01-07 DOI:10.1016/j.diabet.2026.101722

Jakob Starup-Linde , Katrine Hygum , Henrik Støvring , Jens-Erik Beck Jensen , Pia Eiken , Pernille Hermann , Bente Langdahl , Torben Harsløf

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引用次数: 0

Abstract

Aims

Traditional risk factors underestimate fracture risk in individuals with diabetes. In this population-based case-control study we aimed to determine T-score thresholds for type 1 and 2 diabetes (T1D and T2D) with equivalent risk of fractures as that of individuals without diabetes and a T-score of -2.5.

Research Design and Methods

We collected dual energy x-ray absorptiometry (DXA) data (2000–2019), information on diagnoses (1977–2019) and redeemed medications (1997–2019) from the National Danish Registries which are linked by a unique identifier. Cases were individuals with the first incident major osteoporotic fracture (MOF) within two years before or one year after a DXA and controls were fracture free and matched on age, gender, and time period of the DXA. Logistic regression modelling was used in the case-control analysis.

Results

We identified 17,703 cases and 17,703 controls. T1D and T2D were associated with an increased risk of MOF (odds ratio: 1.8, 95 % CI:1.4;2.3 and 1.2, 95 % CI:1.1;1.3, respectively) adjusted for hip BMD. T1D and T2D patients had a similar risk of MOF at T-scores (total hip) = -1.4 and -2.1, respectively, as patients without diabetes with a T-score of -2.5. For hip fracture, the equivalent risk was correspondingly reached with T-scores of -1.9 and -1.6. Similar findings apply for femoral neck and lumbar spine BMD.

Conclusions

Compared to individuals without diabetes, fracture risk was increased in patients with T1D and T2D independent of BMD. Our study suggests that the T-score thresholds for treatment initiation in T1D and T2D should be increased.

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糖尿病患者骨折风险和治疗阈值

传统的风险因素低估了糖尿病患者的骨折风险。在这项以人群为基础的病例对照研究中，我们旨在确定t评分阈值为1型和2型糖尿病（T1D和T2D），其骨折风险与无糖尿病且t评分为-2.5的个体相当。研究设计和方法我们从丹麦国家登记处收集双能x射线吸收仪（DXA）数据（2000-2019年）、诊断信息（1977-2019年）和赎回药物（1997-2019年），这些数据通过唯一标识符链接。病例是在DXA术前2年或术后1年内首次发生严重骨质疏松性骨折（MOF）的个体，对照组是无骨折且DXA的年龄、性别和时间段相匹配的个体。病例-对照分析采用Logistic回归模型。结果共发现病例17703例，对照组17703例。经髋关节骨密度调整后，T1D和T2D与MOF风险增加相关（比值比：1.8,95% CI:1.4；2.3和1.2,95% CI:1.1;1.3）。T1D和T2D患者在t评分（全髋关节）分别为-1.4和-2.1时发生MOF的风险与t评分为-2.5的非糖尿病患者相似。对于髋部骨折，相应达到等效风险，t评分为-1.9和-1.6。类似的结果也适用于股骨颈和腰椎的骨密度。结论与非糖尿病患者相比，独立于BMD的T1D和T2D患者骨折风险增加。我们的研究表明，T1D和T2D患者开始治疗的t评分阈值应该提高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Diabetes & metabolism 医学-内分泌学与代谢

CiteScore

12.00

自引率

4.20%

发文量

审稿时长

13 days

期刊介绍： A high quality scientific journal with an international readership Official publication of the SFD, Diabetes & Metabolism, publishes high-quality papers by leading teams, forming a close link between hospital and research units. Diabetes & Metabolism is published in English language and is indexed in all major databases with its impact factor constantly progressing. Diabetes & Metabolism contains original articles, short reports and comprehensive reviews.