Division of Endocrinology and Metabolism, Department of Internal Medicine, Dongguk University Ilsan Hospital, Goyang, Korea.
Department of Biomedicine & Health Science, The Catholic University of Korea, Seoul, Korea.
Endocrinol Metab (Seoul). 2022 Feb;37(1):148-158. doi: 10.3803/EnM.2021.1315. Epub 2022 Feb 28.
Diabetic kidney disease (DKD) is associated with an elevated risk of fractures. However, little is known about the association between proteinuric or non-proteinuric DKD and the risk of hip fracture. Thus, we investigated the incidence of hip fractures among Korean adults with type 2 diabetes mellitus (T2DM) stratified by DKD phenotype.
In this retrospective cohort study using the Korean National Health Insurance Service database, patients with T2DM who received at least one general health checkup between 2009 and 2012 were followed until the date of hip fracture, death, or December 31, 2018. We classified the DKD phenotype by proteinuria and estimated glomerular filtration rate (eGFR), as follows: no DKD (PU-GFR-), proteinuric DKD with normal eGFR (PU+GFR-), non-proteinuric DKD with reduced eGFR (PU-GFR+), and proteinuric DKD with reduced eGFR (PU+GFR+).
The cumulative incidence of hip fractures was highest in the PU+GFR+ group, followed by the PU-GFR+ group and the PU+GFR- group. After adjustment for confounding factors, the hazard ratio (HR) for hip fracture was still highest in the PU+GFR+ group. However, the PU+GFR- group had a higher HR for hip fracture than the PU-GFR+ group (PU+GFR+ : HR, 1.69; 95% confidence interval [CI], 1.57 to 1.81; PU+GFR- : HR, 1.37; 95% CI, 1.30 to 1.46; PU-GFR+ : HR, 1.20; 95% CI, 1.16 to 1.24 using the PU-GFR- group as the reference category).
The present study demonstrated that DKD was significantly associated with a higher risk of hip fracture, with proteinuria as a major determinant.
糖尿病肾病（DKD）与骨折风险升高有关。然而，人们对蛋白尿或非蛋白尿性 DKD 与髋部骨折风险之间的关系知之甚少。因此，我们调查了韩国 2 型糖尿病（T2DM）患者的 DKD 表型与髋部骨折风险之间的关系。
本回顾性队列研究使用韩国国家健康保险服务数据库，纳入 2009 年至 2012 年间至少接受过一次常规健康检查的 T2DM 患者，随访至髋部骨折、死亡或 2018 年 12 月 31 日。我们通过蛋白尿和估算肾小球滤过率（eGFR）对 DKD 表型进行分类，具体如下：无 DKD（PU-GFR-）、蛋白尿性 DKD 合并正常 eGFR（PU+GFR-）、非蛋白尿性 DKD 合并 eGFR 降低（PU-GFR+）和蛋白尿性 DKD 合并 eGFR 降低（PU+GFR+）。
髋部骨折的累积发生率在 PU+GFR+组最高，其次是 PU-GFR+组和 PU+GFR-组。调整混杂因素后，PU+GFR+组髋部骨折的 HR 仍最高。然而，与 PU-GFR+组相比，PU+GFR-组髋部骨折的 HR 更高（PU+GFR+：HR，1.69；95%置信区间[CI]，1.57 至 1.81；PU+GFR-：HR，1.37；95%CI，1.30 至 1.46；PU-GFR+：HR，1.20；95%CI，1.16 至 1.24，以 PU-GFR-组为参照类别）。
本研究表明，DKD 与髋部骨折风险显著相关，蛋白尿是主要决定因素。
