Departments of Endocrinology & Diabetes, Monash Health, Clayton, Victoria, Australia.
Monash Centre for Health Research and Implementation, School of Public Health and Preventative Medicine, Monash University, Clayton, Victoria, Australia.
Osteoporos Int. 2021 Jun;32(6):1175-1184. doi: 10.1007/s00198-020-05771-9. Epub 2021 Jan 7.
This study evaluated mediators of fracture risk in postmenopausal women with type 1 (T1D) and type 2 diabetes (T2D), over a 15-year follow-up period. This study provides evidence that the increased fracture risk in women with T1D or T2D is partially explained by falls. Furthermore, a shorter reproductive lifespan in women with T1D contributes modestly to fracture risk in this cohort.
Skeletal fragility is associated with diabetes mellitus, while limited estrogen exposure during the reproductive years also predisposes to lower bone mass and higher fracture risk. We aimed to determine osteoporosis diagnosis, fall and fracture rates in women with type 1 (T1D) and type 2 (T2D) diabetes mellitus, and explore mediators of the diabetes-fracture relationship.
Prospective observational data drawn from the Australian Longitudinal Study in Women's Health (ALSWH) from 1996 to 2010. Women were randomly selected from the national health insurance database. Standardized data collection occurred at six survey time points, with main outcome measures being self-reported osteoporosis, incident fracture, falls, and reproductive lifespan. Mediation analyses were performed to elucidate relevant intermediaries in the diabetes-fracture relationship.
Exactly 11,313 women were included at baseline (T1D, n = 107; T2D, n = 333; controls, n = 10,873). A total of 885 new cases of osteoporosis and 1099 incident fractures were reported over 15 years. Women with T1D or T2D reported more falls and fall-related injuries; additionally, women with T1D had a shorter reproductive lifespan. While fracture risk was increased in women with diabetes (T1D: OR 2.28, 95% CI 1.53-3.40; T2D: OR 2.40, 95% CI 1.90-3.03), compared with controls, adjustment for falls attenuated the risk of fracture by 10% and 6% in T1D and T2D, respectively. In women with T1D, reproductive lifespan modestly attenuated fracture risk by 4%.
Women with T1D and T2D have an increased risk of fracture, which may be partially explained by increased falls, and to a lesser extent by shorter reproductive lifespan, in T1D.
骨骼脆弱与糖尿病有关，而生殖期内有限的雌激素暴露也容易导致骨量减少和骨折风险增加。我们旨在确定 1 型（T1D）和 2 型（T2D）糖尿病女性的骨质疏松症诊断、跌倒和骨折发生率，并探讨糖尿病与骨折关系的中介因素。
前瞻性观察性数据来自 1996 年至 2010 年的澳大利亚妇女健康纵向研究（ALSWH）。从国家健康保险数据库中随机选择女性。在六个调查时间点进行了标准化数据收集，主要结局指标为自我报告的骨质疏松症、新发骨折、跌倒和生殖寿命。进行了中介分析，以阐明糖尿病与骨折关系中的相关中介因素。
与对照组相比，T1D 和 T2D 女性的骨折风险增加（T1D：OR 2.28，95%CI 1.53-3.40；T2D：OR 2.40，95%CI 1.90-3.03），但调整跌倒后，T1D 和 T2D 女性的骨折风险分别降低了 10%和 6%。在 T1D 女性中，生殖寿命使骨折风险降低了 4%。
这项研究评估了 15 年随访期间患有 1 型（T1D）和 2 型糖尿病（T2D）的绝经后女性骨折风险的中介因素。这项研究提供的证据表明，T1D 或 T2D 女性骨折风险的增加部分可以通过跌倒来解释。此外，T1D 女性的生殖寿命较短，这也在一定程度上导致了该队列的骨折风险增加。
