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Diabetes and fractures: new evidence of atypical femoral fractures?

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Abstract

Summary

Patients with diabetes have an increased risk of fractures. In this study, subtrochanteric and femoral shaft fractures were increased in patients with type 1 diabetes compared with the general population. In the light of this, more evidence points towards an association between diabetes and atypical femoral fractures.

Introduction

Patients with diabetes have an increased risk of femoral fractures, but little is known about the risk of atypical femoral fractures (AFFs). The aim of this study was to identify the risk of subtrochanteric and femoral shaft (ST/FS) fractures and estimate the risk of AFFs in patients with type 1 (T1D) and type 2 diabetes (T2D).

Methods

From the nationwide Danish National Patient Register, we identified patients with T1D (n = 19,896), T2D (n = 312,188), and sex- and aged-matched controls without diabetes (n = 996,252) from the general population and all ST/FS fractures (n = 7509). Data were analyzed using a Cox proportional-hazards model and the incidence rate and rate ratio of ST/FS fractures were estimated.

Results

The incidence rate of ST/FS fractures in T1D was 52.14 events per 100,000 person years and 73.21 per 100,000 person years in T2D. T1D was associated with an increased risk of ST/FS (HR 2.07 (95% CI 1.68–2.56)), whereas T2D was not (HR 0.99 (95% CI 0.94–1.10)). Previous ST/FS fractures were associated with an increased risk of subsequent ST/FS fractures (HR 6.95 (95% CI 6.00–8.05)) and the use of bisphosphonates with an increased risk of ST/FS fractures (HR 1.72 (95% CI 1.54–1.91)).

Conclusion

Patients with T1D have a higher risk of ST/FS fractures compared with sex- and age-matched controls. Since a proportion of ST/FS fractures are classified as AFFs, this could point towards the fact that AFFs also are increased in patients with T1D, but not T2D.

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Authors and Affiliations

  1. Steno Diabetes Center North, Aalborg University Hospital, Aalborg, Denmark

    N.H. Rasmussen, M.H. Jensen & P. Vestergaard

  2. Department of Endocrinology, Aalborg University Hospital, Aalborg, Denmark

    J. Dal

  3. Department of Clinical Pharmacy & Toxicology, Maastricht UMC+, Maastricht, The Netherlands

    F. de Vries

  4. Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, The Netherlands

    F. de Vries

  5. Department of Internal Medicine, VieCuri Medical Center, Venlo, The Netherlands

    J.P. van den Bergh

  6. Department of Internal Medicine, Maastricht UMC+, Maastricht, The Netherlands

    J.P. van den Bergh

  7. Faculty of Medicine and Life Sciences, University Hasselt, Hasselt, Belgium

    J.P. van den Bergh

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  1. N.H. Rasmussen
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  2. J. Dal
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  4. J.P. van den Bergh
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Correspondence to N.H. Rasmussen.

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Rasmussen, N., Dal, J., de Vries, F. et al. Diabetes and fractures: new evidence of atypical femoral fractures?. Osteoporos Int 31, 447–455 (2020). https://doi.org/10.1007/s00198-019-05224-y

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