Center for Clinical Epidemiology and Methodology, Guangdong Second Provincial General Hospital, Guangzhou, China
Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Diabetes Care. 2019 Apr;42(4):507-513. doi: 10.2337/dc18-1965. Epub 2019 Jan 28.
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.
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.
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 ( = 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.
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.
本研究旨在探讨衰弱是否与骨折风险相关，以及衰弱是否会改变 2 型糖尿病对骨折风险增加的倾向。
数据来自一项前瞻性队列研究。我们的主要结局是首次发生临床脆弱性骨折的时间；次要结局包括髋部骨折和临床脊柱骨折的时间。衰弱状况通过缺陷累积的衰弱指数（FI）来衡量。采用包含交互项（衰弱×糖尿病）的 Cox 模型进行分析。
分析纳入了 3149 名（70%为女性）参与者；其中 138 名（60%为女性）患有糖尿病。与对照组相比，患有糖尿病的参与者具有更高的骨密度和 FI。FI 与新发脆弱性骨折风险之间存在显著的关系，FI 每增加 0.01 和 0.10 的风险比（HR）分别为 1.02（95%CI 1.01-1.03）和 1.19（95%CI 1.10-1.33）。交互作用也具有统计学意义（ = 0.018）。如果将 FI 本身的估计值与交互项的估计值结合起来，那么 FI 每增加 0.1 的 HR 对于患有糖尿病的参与者为 1.33，对于没有糖尿病的参与者为 1.19。对于髋部和临床脊柱骨折风险，没有发现衰弱与糖尿病之间存在交互作用的证据。
患有 2 型糖尿病的参与者明显比没有糖尿病的个体更虚弱。衰弱增加了脆弱性骨折的风险，并增强了糖尿病对脆弱性骨折的影响。对于那些虚弱的人，应特别注意糖尿病作为脆弱性骨折的风险因素。
