Degree of Joint Risk Factor Control and Incident Fracture Outcomes in Individuals With Type 2 Diabetes.

Context: Individuals with type 2 diabetes have a higher fracture risk than the general population. However, the association between joint risk factor control and fracture risk in this population remains unclear.

Objective: To investigate the extent to which joint risk factor control might attenuate the excess risk of fracture outcomes in individuals with type 2 diabetes.

Methods: We included 8935 individuals with type 2 diabetes and 35 740 matched controls without fractures at baseline from the UK Biobank (UKB), with a median follow-up of 12.1 years. Six modifiable risk factors were assessed: body mass index (BMI), physical activity, smoking, alcohol consumption, serum 25-hydroxyvitamin D (25(OH)D), and glycated hemoglobin A1c (HbA1c). Cox proportional hazards models were used to estimate associations between risk factor control and fracture risk.

Results: Controlling each additional risk factor resulted in a 14% to 26% decrease in fracture risk. Optimal control (≥5 risk factors) correlated with a 50% reduction in overall fractures (HR 0.50; 95% CI 0.33-0.75). However, a 60% reduction in hip fractures (HR 0.40; 95% CI 0.16-0.98) was observed with the control of 4 risk factors. With control of 4 or more risk factors, fracture risk in individuals with type 2 diabetes was comparable to that of nondiabetic controls, and the protective effect was stronger in men than in women.

Conclusion: Joint risk factor control was significantly linked to a reduced fracture risk, and optimal management may eliminate the excess fracture risk associated with type 2 diabetes.