GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, CIBERFES ISCIII, Universitat Autonoma de Barcelona, Barcelona, Spain.
Ambit Barcelona, Primary Care Department, Institut Catala de la Salut, Barcelona, Spain.
Osteoporos Int. 2017 Sep;28(9):2573-2581. doi: 10.1007/s00198-017-4096-y. Epub 2017 Jul 25.
Post-fracture mortality in type 2 diabetes mellitus (T2DM) patients has been poorly studied. We report an absolute and relative excess all-cause mortality following a fracture in these patients compared to non-diabetic patients.
T2DM and osteoporotic fractures are independently associated with a reduced lifespan, but it is unknown if T2DM confers an excess post-fracture mortality compared to non-diabetic fracture patients. We report post-fracture all-cause mortality according to T2DM status.
This is a population-based cohort study using data from the SIDIAP database. All ≥50 years old T2DM patients registered in SIDIAP in 2006-2013 and two diabetes-free controls matched on age, gender, and primary care center were selected. Study outcome was all-cause mortality following incident fractures. Participants were followed from date of any fracture (AF), hip fracture (HF), and clinical vertebral fracture (VF) until the earliest of death or censoring. Cox regression was used to calculate mortality according to T2DM status after adjustment for age, gender, body mass index, smoking, alcohol intake, and previous ischemic heart and cerebrovascular disease.
We identified 166,106 T2DM patients and 332,212 non-diabetic, of which 11,066 and 21,564, respectively, sustained a fracture and were then included. Post-fracture mortality rates (1000 person-years) were (in T2DM vs non-diabetics) 62.7 vs 49.5 after AF, 130.7 vs 112.7 after HF, and 54.9 vs 46.2 after VF. Adjusted HR (95% CI) for post-AF, post-HF, and post-VF mortality was 1.30 (1.23-1.37), 1.28 (1.20-1.38), and 1.20 (1.06-1.35), respectively, for T2DM compared to non-diabetics.
T2DM patients have a 30% increased post-fracture mortality compared to non-diabetics and a remarkable excess in absolute mortality risk. More research is needed on the causes underlying such excess risk, and on the effectiveness of measures to reduce post-fracture morbi-mortality in T2DM subjects.
研究 2 型糖尿病（T2DM）患者骨折后死亡率是否高于非糖尿病患者。
本研究为基于人群的队列研究，使用了 SIDIAP 数据库的数据。选择 2006 年至 2013 年期间在 SIDIAP 登记的所有年龄≥50 岁的 T2DM 患者，并与年龄、性别和初级保健中心相匹配的两名无糖尿病对照者。研究结局为发生骨折后的全因死亡率。患者从任何骨折（AF）、髋部骨折（HF）和临床椎体骨折（VF）发生之日起至死亡或失访的最早时间接受随访。使用 Cox 回归计算 T2DM 状态校正后年龄、性别、体重指数、吸烟、饮酒和既往缺血性心脏病和脑血管病后全因死亡率。
我们确定了 166106 名 T2DM 患者和 332212 名非糖尿病患者，其中分别有 11066 名和 21564 名患者发生了骨折，然后被纳入研究。骨折后死亡率（每 1000 人年）分别为 T2DM 患者（62.7）和非糖尿病患者（49.5）；HF 患者分别为 130.7 和 112.7；VF 患者分别为 54.9 和 46.2。T2DM 患者与非糖尿病患者相比，AF 后、HF 后和 VF 后死亡率的调整 HR（95%CI）分别为 1.30（1.23-1.37）、1.28（1.20-1.38）和 1.20（1.06-1.35）。
与非糖尿病患者相比，T2DM 患者骨折后死亡率增加 30%，绝对死亡风险显著增加。需要进一步研究导致这种超额风险的原因，以及减少 T2DM 患者骨折后发病率和死亡率的措施的有效性。
