Department of Anesthesiology, Taipei Medical University Hospital, Taipei, TaiwanHealth Policy Research Center, Taipei Medical University Hospital, Taipei, TaiwanSchool of Medicine, Taipei Medical University, Taipei, Taiwan.
School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan.
Diabetes Care. 2014 Aug;37(8):2246-52. doi: 10.2337/dc13-2957. Epub 2014 May 7.
The relationship between diabetes and fracture is not completely understood. This study evaluated fracture risk and postfracture mortality in patients with diabetes.
We identified 32,471 adults newly diagnosed with diabetes in 2000-2003 using Taiwan's National Health Insurance Research Database. A comparison cohort of 64,942 adults without diabetes was randomly selected from the same dataset, with frequency matched by age and sex. Fracture events in 2000-2008 were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% CIs of fracture associated with diabetes were calculated. A nested cohort study of 17,002 patients with fracture receiving repair surgeries between 2004 and 2010 calculated adjusted odds ratios (ORs) and 95% CIs of adverse events after fracture in patients with and without diabetes.
During 652,530 person-years of follow-up, there were 12,772 newly diagnosed fracture cases. The incidences of fracture for people with diabetes and without were 24.2 and 17.1 per 1,000 person-years, respectively (P < 0.0001). Compared with people without diabetes, the adjusted HR of fracture was 1.66 (95% CI 1.60-1.72) for people with diabetes. The ORs of postfracture deep wound infection, septicemia, and mortality associated with diabetes were 1.34 (95% CI 1.06-1.71), 1.42 (95% CI 1.23-1.64), and 1.27 (95% CI 1.02-1.60), respectively.
Diabetes was associated with fracture. Patients with diabetes had more adverse events and subsequent mortality after fracture. Prevention of fracture and postfracture adverse events is needed in this susceptible population.
糖尿病与骨折之间的关系尚未完全明确。本研究评估了糖尿病患者的骨折风险和骨折后死亡率。
我们使用台湾全民健康保险研究数据库，于 2000-2003 年识别出 32471 例新诊断为糖尿病的成年人。从同一数据集随机选择了 64942 例无糖尿病的成年人作为对照组，通过年龄和性别进行频率匹配。2000-2008 年的骨折事件从医疗索赔中确定。计算了与糖尿病相关的骨折的校正风险比（HR）和 95%置信区间（CI）。对 2004 年至 2010 年间接受修复手术的 17002 例骨折患者进行嵌套队列研究，计算了有和无糖尿病患者骨折后不良事件的校正比值比（OR）和 95%CI。
在 652530 人年的随访期间，新诊断出骨折病例 12772 例。有糖尿病和无糖尿病的骨折发生率分别为 24.2 和 17.1/1000 人年（P<0.0001）。与无糖尿病者相比，糖尿病患者骨折的校正 HR 为 1.66（95%CI 1.60-1.72）。糖尿病与骨折后深部伤口感染、败血症和死亡率相关的 OR 分别为 1.34（95%CI 1.06-1.71）、1.42（95%CI 1.23-1.64）和 1.27（95%CI 1.02-1.60）。
糖尿病与骨折相关。糖尿病患者骨折后发生不良事件和后续死亡的风险更高。在这一易感人群中，需要预防骨折和骨折后不良事件。
