Risk of Fracture in Women with Type 2 Diabetes: the Women’s Health Initiative Observational Study

TLDR

Prior studies have reported higher fracture rates in individuals with type 2 diabetes, but findings are inconsistent. This study aimed to quantify fracture risk in postmenopausal women with type 2 diabetes and examine variation by fracture site, ethnicity, and baseline bone density. Using the Women’s Health Initiative Observational Cohort, 93,676 postmenopausal women with and without diagnosed diabetes were followed for seven years, with fractures recorded at specific anatomical sites. Women with type 2 diabetes had a 20 % higher overall fracture risk (RR 1.20) and increased risk at hip/pelvis, foot, and spine sites, especially among black women (RR 1.33) and those with higher baseline BMD (RR 1.26), despite having greater hip and spine bone mineral density.

Abstract

Some but not all studies have shown higher rates of fracture in individuals with type 2 diabetes.The objective of the study was to determine the risk of fracture in postmenopausal women with type 2 diabetes and determine whether risk varies by fracture site, ethnicity, and baseline bone density.Women with clinically diagnosed type 2 diabetes at baseline in the Women's Health Initiative Observational Cohort, a prospective study of postmenopausal women (n = 93,676), were compared with women without diagnosed diabetes and risk of fracture overall and at specific sites determined.All fractures and specific sites separately (hip/pelvis/upper leg; lower leg/ankle/knee; foot; upper arm/shoulder/elbow; lower arm/wrist/hand; spine/tailbone) were measured. Bone mineral density (BMD) in a subset also was measured.The overall risk of fracture after 7 yr of follow-up was higher in women with diabetes at baseline after controlling for multiple risk factors including frequency of falls [adjusted relative risk (RR) 1.20, 95% confidence interval (CI) 1.11-1.30]. In a subsample of women with baseline BMD scores, women with diabetes had greater hip and spine BMD. The elevated fracture risk was found at multiple sites (hip/pelvis/upper leg; foot; spine/tailbone) among black women (RR 1.33, 95% CI 1.00-1.75) and women with increased baseline bone density (RR 1.26, 95% CI 0.96-1.66).Women with type 2 diabetes are at increased risk for fractures. This risk is also seen among black and non-Hispanic white women after adjustment for multiple risk factors including frequent falls and increased BMD (in a subset).