2004-2018 年丹麦全国队列研究：糖尿病对 92600 例髋部骨折患者随后骨折风险的影响。

Impact of diabetes on the risk of subsequent fractures in 92,600 patients with an incident hip fracture: A Danish nationwide cohort study 2004-2018.

机构信息

Department of Clinical Epidemiology, Department of Clinical Medicine, Aarhus University and Aarhus University Hospital, Aarhus, Denmark.

The Norwegian Arthroplasty Register, Department of Orthopaedic Surgery, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.

出版信息

Bone. 2024 Jul;184:117104. doi: 10.1016/j.bone.2024.117104. Epub 2024 Apr 16.

DOI:10.1016/j.bone.2024.117104

PMID:38636621

Abstract

PURPOSE

We investigated the incidence rates of a subsequent hip fracture (HF) and other subsequent fractures than HF after first incident HF, comparing patients with and without diabetes.

METHODS

Using Danish medical databases, we identified 92,600 incident HF patients in the period 2004-2018. Diabetes exposure was examined overall, by type of diabetes (T2D and T1D), and by presence of diabetes complications. We estimated cumulative incidence of subsequent HFs and fractures other than HF within two years of the incident HF. Using Cox regression, adjusted hazard ratios (aHRs) with 95 % confidence interval (CI) were calculated.

RESULTS

Among incident HF patients, 11,469 (12 %) had diabetes, of whom 10,253 (89 %) had T2D and 1216 (11 %) had T1D. The 2-year incidence rates for a new subsequent HF were 4.8 % (95 % CI: 4.6-4.9) for patients without diabetes (reference group), 4.1 % (95 % CI: 3.8-4.6) for T2D, and 4.3 % (95 % CI: 3.3-5.6) for T1D. Corresponding aHRs were 1.01 (95 % CI 0.90-1.14) for T2D and 1.17 (95 % CI 0.87-1.58) for T1D. There was effect modification by sex, as women with T1D had an aHR of 1.52 (95 % CI: 1.09-2.11) for subsequent HF, and by specific diabetes complications (for example, patients with T2D and prior hypoglycemia had an aHR of 1.75 (95 % CI: 1.24-2.42) for subsequent HF, while patients with T1D and neuropathy had an aHR of 1.73 (95 %: 1.09-2.75), when compared with patients without diabetes). For fractures other than HF, the 2-year incidence rates were 7.3 % (95 % CI: 7.2-7.5) for patients without diabetes, 6.6 % (95 % CI: 6.1-7.1) for T2D, and 8.5 % (95 % CI: 7.0-10.1) for T1D, with corresponding aHRs of 1.01 (95 % CI 0.92-1.11) for T2D and 1.43 (95 % CI: 1.16-1.78) for T1D. T2D was only a risk factor for other subsequent fractures among HF patients of high age (age 86-89 years: aHR 1.22 (95 % CI 0.99-1.55), age 90+ years: aHR 1.37 (95 % CI 1.08-1.74)), whereas T1D was robustly associated with increased risk of fractures other than HF in all subgroups.

CONCLUSION

Among HF patients, we found no strong overall association of T2D or T1D with increased risk of subsequent HF, but diabetes patients with prior hypoglycemic events or neuropathy were at increased risk. In contrast, patients with T1D had a clearly increased risk of subsequent fractures other than HF.

摘要

目的

我们调查了首次发生髋部骨折（HF）后后续 HF 和其他骨折的发生率，比较了有和没有糖尿病的患者。

方法

使用丹麦医疗数据库，我们在 2004 年至 2018 年期间确定了 92600 名首次 HF 患者。检查了总体糖尿病暴露情况、2 型糖尿病（T2D）和 1 型糖尿病（T1D）的类型以及糖尿病并发症的存在情况。我们估计了在首次 HF 后两年内发生的后续 HF 和其他非 HF 骨折的累积发生率。使用 Cox 回归，计算了调整后的危险比（aHR）及其 95%置信区间（CI）。

结果

在首次 HF 患者中，11469 名（12%）患有糖尿病，其中 10253 名（89%）患有 T2D，1216 名（11%）患有 T1D。无糖尿病患者（参考组）的新后续 HF 2 年发生率为 4.8%（95%CI：4.6-4.9），T2D 为 4.1%（95%CI：3.8-4.6），T1D 为 4.3%（95%CI：3.3-5.6）。相应的 aHR 分别为 T2D 1.01（95%CI 0.90-1.14）和 T1D 1.17（95%CI 0.87-1.58）。存在性别效应修饰，即 T1D 女性发生后续 HF 的 aHR 为 1.52（95%CI：1.09-2.11），特定的糖尿病并发症也存在效应修饰（例如，有 T2D 和既往低血糖事件的患者发生后续 HF 的 aHR 为 1.75（95%CI：1.24-2.42），而有 T1D 和神经病变的患者发生后续 HF 的 aHR 为 1.73（95%：1.09-2.75），与无糖尿病患者相比）。对于其他非 HF 骨折，无糖尿病患者的 2 年发生率为 7.3%（95%CI：7.2-7.5），T2D 为 6.6%（95%CI：6.1-7.1），T1D 为 8.5%（95%CI：7.0-10.1），相应的 aHR 分别为 T2D 1.01（95%CI 0.92-1.11）和 T1D 1.43（95%CI：1.16-1.78）。T2D 仅在高龄（86-89 岁：aHR 1.22（95%CI 0.99-1.55），90 岁以上：aHR 1.37（95%CI 1.08-1.74））的 HF 患者中是后续 HF 的危险因素，而 T1D 在所有亚组中与非 HF 骨折风险增加均显著相关。