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. 2020 Jun 1;105(6). doi: 10.1210/clinem/dgaa141.
Diabetes mellitus (DM) is associated with an increased risk of fracture, but it is not clear which diabetes and nondiabetes risk factors may be most important.
The aim of the study was to evaluate risk factors for incident major osteoporotic fractures (MOFs) of the hip, wrist, and humerus in African American (AA), Hispanic (HIS), and Caucasian (CA) subjects with DM.
This was a retrospective cohort study of 18 210 subjects with DM (7298 CA, 7009 AA and 3903 HIS) at least 40 years of age, being followed at a large healthcare system in Philadelphia, Pennsylvania.
In a global model in CA with DM, MOF were associated with dementia (HR 4.16; 95% CI, 2.13-8.12), OSA (HR 3.35; 95% CI, 1.78-6.29), COPD (HR 2.43; 95% CI, 1.51-3.92), and diabetic neuropathy (HR 2.52; 95% CI, 1.41-4.50). In AA, MOF were associated with prior MOF (HR 13.67; 95% CI, 5.48-34.1), dementia (HR 3.10; 95% CI, 1.07-8.98), glomerular filtration rate (GFR) less than 45 (HR 2.05; 95% CI, 1.11-3.79), thiazide use (HR 0.54; 95% CI, 0.31-0.93), metformin use (HR 0.59; 95% CI, 0.36-0.97), and chronic steroid use (HR 5.03; 95% CI, 1.51-16.7). In HIS, liver disease (HR 3.06; 95% CI, 1.38-6.79) and insulin use (HR 2.93; 95% CI, 1.76-4.87) were associated with MOF.
In patients with diabetes, the risk of fracture is related to both diabetes-specific variables and comorbid conditions, but these relationships vary by race/ethnicity.
糖尿病与骨折风险增加相关，但尚不清楚哪些糖尿病和非糖尿病危险因素可能更为重要。
本研究旨在评估非裔美国人（AA）、西班牙裔（HIS）和高加索人（CA）糖尿病患者发生髋部、腕部和肱骨主要骨质疏松性骨折（MOF）的危险因素。
这是一项回顾性队列研究，共纳入了 18210 名至少 40 岁、在宾夕法尼亚州费城的一家大型医疗保健系统中接受治疗的糖尿病（7298 名 CA、7009 名 AA 和 3903 名 HIS）患者。
在 CA 合并糖尿病的全球模型中，MOF 与痴呆（HR 4.16；95%CI，2.13-8.12）、阻塞性睡眠呼吸暂停（OSA；HR 3.35；95%CI，1.78-6.29）、慢性阻塞性肺疾病（COPD；HR 2.43；95%CI，1.51-3.92）和糖尿病性神经病（HR 2.52；95%CI，1.41-4.50）相关。在 AA 中，MOF 与既往 MOF（HR 13.67；95%CI，5.48-34.1）、痴呆（HR 3.10；95%CI，1.07-8.98）、肾小球滤过率（GFR）＜45（HR 2.05；95%CI，1.11-3.79）、噻嗪类药物使用（HR 0.54；95%CI，0.31-0.93）、二甲双胍使用（HR 0.59；95%CI，0.36-0.97）和慢性皮质类固醇使用（HR 5.03；95%CI，1.51-16.7）相关。在 HIS 中，肝脏疾病（HR 3.06；95%CI，1.38-6.79）和胰岛素使用（HR 2.93；95%CI，1.76-4.87）与 MOF 相关。
在糖尿病患者中，骨折风险与糖尿病特异性变量和合并症有关，但这些关系因种族/民族而异。
