Chiang J I-H, Li T-C, Li C-I, Liu C-S, Meng N-H, Lin W-Y, Yang S-Y, Chen H-J, Lin C-C
Department of General Practice, Faculty of Medicine, Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia.
Graduate Institute of Biostatistics, College of Public Health, China Medical University, Taichung, Taiwan.
Osteoporos Int. 2016 Dec;27(12):3587-3597. doi: 10.1007/s00198-016-3689-1. Epub 2016 Jun 30.
We investigated the association between fasting plasma glucose variability (FPG-CV) and the risk of hip fracture in elderly diabetic patients. Our finding showed a temporal association between FPG-CV and hip fracture as patients categorized as FPG-CV greater than 25.4 % showed an increased risk in hip fractures.
Hip fracture is a major health burden in the population and is associated with high rates of mortality and morbidity especially in elderly. It is evident that diabetes mellitus is a risk factor of osteoporosis which is a significant risk factor of hip fracture. However, epidemiological studies exploring the risks of hip fracture among type 2 diabetic patients are limited.
A retrospective study of 26,501 ethnic Chinese older persons enrolled in the National Diabetes Care Management program in Taiwan was conducted; related factors were analyzed with extended Cox proportional hazards regression models to competing risk data on hip fracture incidence.
The results show a temporal association between FPG-CV and hip fracture as patients categorized as FPG-CV greater than 25.4 % showed an increased risk in hip fractures, confirming a linear relationship between the two. After multivariate adjustment, the risk of hip fracture increased among patients with FPG-CV of 25.4-42.3 % and >42.3 % compared with patients with FPG-CV of ≦ 14.3 % (hazard ratio, 1.35; 95 % confidence interval 1.14-1.60 and 1.27; 1.07-1.52, respectively). Significant linear trends among various FPG-CV were observed.
Thus, the present study demonstrated the importance of glucose stability for fracture prevention in older persons with type 2 diabetes. Future studies should be conducted to explore whether reduction in glucose oscillation in older adults with diabetes mellitus can reduce the risk of hip fracture.
我们研究了老年糖尿病患者空腹血糖变异性（FPG-CV）与髋部骨折风险之间的关联。我们的研究结果显示，FPG-CV与髋部骨折之间存在时间关联，因为FPG-CV大于25.4%的患者髋部骨折风险增加。
髋部骨折是人群中的一项重大健康负担，尤其是在老年人中，其与高死亡率和高发病率相关。显然，糖尿病是骨质疏松症的一个风险因素，而骨质疏松症是髋部骨折的一个重要风险因素。然而，探索2型糖尿病患者髋部骨折风险的流行病学研究有限。
对参加台湾国家糖尿病照护管理计划的26501名华裔老年人进行了一项回顾性研究；使用扩展的Cox比例风险回归模型对髋部骨折发生率的竞争风险数据进行相关因素分析。
结果显示FPG-CV与髋部骨折之间存在时间关联，因为FPG-CV大于25.4%的患者髋部骨折风险增加，证实了两者之间的线性关系。多变量调整后，FPG-CV为25.4%-42.3%和>42.3%的患者与FPG-CV≤14.3%的患者相比，髋部骨折风险增加（风险比分别为1.35；95%置信区间1.14-1.60和1.27；1.07-1.52）。在不同的FPG-CV之间观察到显著的线性趋势。
因此，本研究证明了血糖稳定性对2型糖尿病老年人预防骨折的重要性。未来应进行研究，以探索降低糖尿病老年人的血糖波动是否可以降低髋部骨折风险。
