Section of Endocrinology, Diabetes, and Metabolism, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
Department of Clinical Sciences, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania.
J Clin Endocrinol Metab. 2019 Nov 1;104(11):5729-5736. doi: 10.1210/jc.2019-00931.
Diabetes mellitus (DM) has been associated with a 60% to 90% increased risk of fracture but few studies have been performed in African American and Hispanic subjects.
The aim of the present study was to quantify the risk of incident major osteoporotic fractures (MOFs) of the hip, wrist, and humerus in African Americans, Hispanics, and Caucasians with DM compared with those with hypertension (HTN).
We performed a retrospective cohort study of 19,153 subjects with DM (7618 Caucasians, 7456 African Americans, and 4079 Hispanics) and 26,217 with HTN (15,138 Caucasians, 8301 African Americans, and 2778 Hispanics) aged ≥40 years, treated at a large health care system in Philadelphia, Pennsylvania. All information about the subjects was obtained from electronic health records.
The unadjusted MOF rates for each race/ethnicity were similar among those with DM and those with HTN (Caucasians, 1.85% vs 1.84%; African Americans, 1.07% vs 1.29%; and Hispanics, 1.69% vs 1.33%; P = NS for all). However, the MOF rates were higher for Caucasians and Hispanics with DM than for African Americans with DM (P < 0.01). In a multivariable model controlled for age, body mass index, sex, and previous MOF, DM was a statistically significant predictor of MOFs only for Caucasians and Hispanics [hazard ratio (HR), 1.23; 95% CI, 1.02 to 1.48; P = 0.026] but not for African Americans (HR, 0.92; 95% CI, 0.68 to 1.23; P = 0.56).
Hispanics had a DM-related fracture risk similar to that of Caucasians, but AAs did not have an additional fracture risk conferred by DM.
糖尿病（DM）与骨折风险增加 60%至 90%相关，但在非裔美国人和西班牙裔人群中进行的研究较少。
本研究旨在量化非裔美国人、西班牙裔和白种人糖尿病患者与高血压（HTN）患者相比，发生髋部、腕部和肱骨主要骨质疏松性骨折（MOFs）的风险。
我们对宾夕法尼亚州费城一家大型医疗保健系统中年龄≥40 岁的 19153 例糖尿病（7618 例白种人、7456 例非裔美国人、4079 例西班牙裔）和 26217 例高血压（15138 例白种人、8301 例非裔美国人、2778 例西班牙裔）患者进行了回顾性队列研究。所有患者信息均来自电子健康记录。
在未调整的情况下，DM 各种族/族裔的 MOF 发生率在 DM 组和 HTN 组之间相似（白种人，1.85%vs1.84%；非裔美国人，1.07%vs1.29%；西班牙裔，1.69%vs1.33%；所有 P 值均无统计学意义）。然而，DM 白种人和西班牙裔患者的 MOF 发生率高于 DM 非裔美国人（P<0.01）。在多变量模型中，调整年龄、体重指数、性别和既往 MOF 后，DM 仅对白种人和西班牙裔是 MOF 的统计学显著预测因素[风险比（HR），1.23；95%置信区间，1.02 至 1.48；P=0.026]，而对非裔美国人则不是（HR，0.92；95%置信区间，0.68 至 1.23；P=0.56）。
西班牙裔的 DM 相关骨折风险与白种人相似，但非裔美国人没有因 DM 而增加骨折风险。
