Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles.
Department of Epidemiology, School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania.
JAMA Netw Open. 2023 May 1;6(5):e2314835. doi: 10.1001/jamanetworkopen.2023.14835.
Whether prediabetes is associated with fracture is uncertain.
To evaluate whether prediabetes before the menopause transition (MT) is associated with incident fracture during and after the MT.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study used data collected between January 6, 1996, and February 28, 2018, in the Study of Women's Health Across the Nation cohort study, an ongoing, US-based, multicenter, longitudinal study of the MT in diverse ambulatory women. The study included 1690 midlife women in premenopause or early perimenopause at study inception (who have since transitioned to postmenopause) who did not have type 2 diabetes before the MT and who did not take bone-beneficial medications before the MT. Start of the MT was defined as the first visit in late perimenopause (or first postmenopausal visit if participants transitioned directly from premenopause or early perimenopause to postmenopause). Mean (SD) follow-up was 12 (6) years. Statistical analysis was conducted from January to May 2022.
Proportion of visits before the MT that women had prediabetes (fasting glucose, 100-125 mg/dL [to convert to millimoles per liter, multiply by 0.0555]), with values ranging from 0 (prediabetes at no visits) to 1 (prediabetes at all visits).
Time to first fracture after the start of the MT, with censoring at first diagnosis of type 2 diabetes, initiation of bone-beneficial medication, or last follow-up. Cox proportional hazards regression was used to examine the association (before and after adjustment for bone mineral density) of prediabetes before the MT with fracture during the MT and after menopause.
This analysis included 1690 women (mean [SD] age, 49.7 [3.1] years; 437 Black women [25.9%], 197 Chinese women [11.7%], 215 Japanese women [12.7%], and 841 White women [49.8%]; mean [SD] body mass index [BMI] at the start of the MT, 27.6 [6.6]). A total of 225 women (13.3%) had prediabetes at 1 or more study visits before the MT, and 1465 women (86.7%) did not have prediabetes before the MT. Of the 225 women with prediabetes, 25 (11.1%) sustained a fracture, while 111 of the 1465 women without prediabetes (7.6%) sustained a fracture. After adjustment for age, BMI, and cigarette use at the start of the MT; fracture before the MT; use of bone-detrimental medications; race and ethnicity; and study site, prediabetes before the MT was associated with more subsequent fractures (hazard ratio for fracture with prediabetes at all vs no pre-MT visits, 2.20 [95% CI, 1.11-4.37]; P = .02). This association was essentially unchanged after controlling for BMD at the start of the MT.
This cohort study of midlife women suggests that prediabetes was associated with risk of fracture. Future research should determine whether treating prediabetes reduces fracture risk.
糖尿病前期与骨折的关系尚不确定。
评估女性更年期过渡（MT）前的糖尿病前期是否与 MT 期间和之后的骨折有关。
设计、地点和参与者： 这项队列研究使用了 1996 年 1 月 6 日至 2018 年 2 月 28 日期间在美国进行的全国妇女健康研究（一项对不同门诊女性 MT 的正在进行的、基于美国的、多中心、纵向研究）的数据。该研究包括 1690 名在研究开始时处于绝经前或早期围绝经期的中年女性（她们此后已过渡到绝经后），这些女性在 MT 前没有 2 型糖尿病，且在 MT 前没有服用对骨骼有益的药物。MT 的开始被定义为晚围绝经期的第一次就诊（如果参与者直接从绝经前或早期围绝经期过渡到绝经后，则为第一次绝经后就诊）。平均（SD）随访时间为 12（6）年。统计分析于 2022 年 1 月至 5 月进行。
在 MT 前的就诊中，女性患有糖尿病前期的比例（空腹血糖 100-125mg/dL[转换为毫摩尔/升，乘以 0.0555]），范围从 0（就诊时无糖尿病前期）到 1（就诊时均有糖尿病前期）。
在 MT 开始后发生首次骨折的时间，以首次诊断 2 型糖尿病、开始使用对骨骼有益的药物或最后一次随访为截止点。使用 Cox 比例风险回归来检查 MT 期间和绝经后糖尿病前期与骨折的关联（在调整骨密度之前和之后）。
这项分析包括 1690 名女性（平均[SD]年龄 49.7[3.1]岁；黑人女性 437 名[25.9%]，中国女性 197 名[11.7%]，日本女性 215 名[12.7%]，白人女性 841 名[49.8%]；MT 开始时的平均[SD]体重指数[BMI]为 27.6[6.6]）。共有 225 名女性（13.3%）在 MT 前的 1 次或多次就诊中患有糖尿病前期，1465 名女性（86.7%）在 MT 前没有糖尿病前期。在患有糖尿病前期的 225 名女性中，有 25 名（11.1%）发生了骨折，而在没有糖尿病前期的 1465 名女性中，有 111 名（7.6%）发生了骨折。在调整 MT 开始时的年龄、BMI 和吸烟情况、MT 前的骨折、使用对骨骼有害的药物、种族和民族以及研究地点后，糖尿病前期与更多随后的骨折有关（糖尿病前期所有就诊与无 MT 前就诊相比，骨折的风险比为 2.20[95%CI，1.11-4.37]；P=0.02）。在控制 MT 开始时的 BMD 后，这种关联基本保持不变。
这项针对中年女性的队列研究表明，糖尿病前期与骨折风险相关。未来的研究应确定治疗糖尿病前期是否能降低骨折风险。
