Frailty and Risk of Fractures in Patients With Type 2 Diabetes
| Autor: | David Goltzman, Lehana Thabane, Mitchell Levine, Robert G. Josse, Christopher S. Kovacs, K. Shawn Davison, Tanveer Towheed, Jonathan D. Adachi, Tassos Anastassiades, Alexandra Papaioannou, William D. Leslie, Jerilynn C. Prior, Guowei Li, Stephanie M. Kaiser |
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| Rok vydání: | 2019 |
| Předmět: |
Male
Research design Canada medicine.medical_specialty Frail Elderly Endocrinology Diabetes and Metabolism 030209 endocrinology & metabolism Type 2 diabetes Diabetes Complications Fractures Bone 03 medical and health sciences 0302 clinical medicine Risk Factors Internal medicine Diabetes mellitus Prevalence Internal Medicine Humans Medicine Prospective Studies 030212 general & internal medicine Risk factor Prospective cohort study Aged Proportional Hazards Models Advanced and Specialized Nursing Hip fracture Frailty Hip Fractures business.industry Proportional hazards model Hazard ratio Middle Aged medicine.disease Diabetes Mellitus Type 2 Osteoporosis Female business |
| Zdroj: | Diabetes Care. 42:507-513 |
| ISSN: | 1935-5548 0149-5992 |
| DOI: | 10.2337/dc18-1965 |
| Popis: | OBJECTIVE We aimed to explore whether frailty was associated with fracture risk and whether frailty could modify the propensity of type 2 diabetes toward increased risk of fractures. RESEARCH DESIGN AND METHODS Data were from a prospective cohort study. Our primary outcome was time to the first incident clinical fragility fracture; secondary outcomes included time to hip fracture and to clinical spine fracture. Frailty status was measured by a Frailty Index (FI) of deficit accumulation. The Cox model incorporating an interaction term (frailty × diabetes) was used for analyses. RESULTS The analysis included 3,149 (70% women) participants; 138 (60% women) had diabetes. Higher bone mineral density and FI were observed in participants with diabetes compared with control subjects. A significant relationship between the FI and the risk of incident fragility fractures was found, with a hazard ratio (HR) of 1.02 (95% CI 1.01–1.03) and 1.19 (95% CI 1.10–1.33) for per-0.01 and per-0.10 FI increase, respectively. The interaction was also statistically significant (P = 0.018). The HR for per-0.1 increase in the FI was 1.33 for participants with diabetes and 1.19 for those without diabetes if combining the estimate for the FI itself with the estimate from the interaction term. No evidence of interaction between frailty and diabetes was found for risk of hip and clinical spine fractures. CONCLUSIONS Participants with type 2 diabetes were significantly frailer than individuals without diabetes. Frailty increases the risk of fragility fracture and enhances the effect of diabetes on fragility fractures. Particular attention should be paid to diabetes as a risk factor for fragility fractures in those who are frail. |
| Databáze: | OpenAIRE |
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