OBJECTIVE There is growing evidence that weight loss is associated with increased fracture risk in the general population. As patients with diabetes often lose weight intentionally or unintentionally, we aimed to investigate prospectively the relationship between weight loss from maximum body weight and fracture risk.

RESEARCH DESIGN AND METHODS A total of 4,706 Japanese participants with type 2 diabetes (mean age 66 years), including 2,755 men and 1,951 postmenopausal women, were followed for a median of 5.3 years and were divided according to weight loss from maximum weight: <10%, 10% to <20%, 20% to <30%, and ≥30%. The primary outcomes were fragility fractures defined as fractures at sites of hip and spine.

RESULTS During the follow-up period, fragility fractures occurred in 198 participants. The age- and sex-adjusted incidence rates per 1,000 person-years in all participants were 6.4 (<10% weight loss from maximum body weight), 7.8 (10% to <20%), 11.7 (20% to <30%), and 19.2 (≥30%) (P for trend <0.001). Multivariate-adjusted hazard ratios for fragility fractures compared with reference (<10% weight loss) were 1.48 (95% CI 0.79–2.77) in the 10% to <20% group, 2.23 (1.08–4.64) in 20% to <30%, and 5.20 (2.15–12.57) in ≥30% in men, and 1.19 (0.78–1.82) in 10% to <20%, 1.62 (0.96–2.73) in 20% to <30%, and 1.97 (0.84–4.62) in ≥30% in postmenopausal women.

CONCLUSIONS The current study demonstrates that ≥20% body weight loss from maximum weight is a significant risk factor for fragility fractures in patients with type 2 diabetes, especially in men.

目的越来越多的证据表明，体重减轻与普通人群骨折风险增加有关。由于糖尿病患者经常有意或无意地减轻体重，因此我们旨在前瞻性研究最大体重减轻与骨折风险之间的关系。

研究设计与方法总共对4,706名日本2型糖尿病患者（平均年龄66岁）进行了随访，其中包括2,755名男性和1,951名绝经后女性，平均中位时间为5.3年，并根据最大体重减轻的体重进行了划分：<10 ％，10％至<20％，20％至<30％和≥30％。主要结果是脆性骨折，定义为髋部和脊柱部位的骨折。

结果在随访期间，198名参与者发生了脆性骨折。所有参加者的每1000人年的年龄和性别调整后的发病率分别为6.4（从最大体重下降<10％），7.8（10％至<20％），11.7（20％至<30％） ，和19.2（≥30％）（趋势<0.001的P）。与参考（<10％体重减轻）相比，脆性骨折的多因素校正风险比在10％至<20％组中为1.48（95％CI 0.79-2.77），在20％至<30中为2.23（1.08-4.64）。 ％，≥30％的男性为5.20（2.15–12.57），10％至<20％的为1.19（0.78–1.82），20％至<30％的为1.62（0.96-2.73），1.97（0.84–绝经后妇女中≥30％的占4.62）。

结论当前的研究表明，最大体重减轻20％以上的体重是2型糖尿病患者尤其是男性易碎性骨折的重要危险因素。