| アブストラクト | OBJECTIVE: This study aimed to determine the hazard ratios (HR) for various fracture sites and identify associated risk factors in a cohort of relatively healthy adult people with newly diagnosed type 1 diabetes (T1D). METHODS: The study utilized data from the UK Clinical Practice Research Datalink GOLD (1987-2017). Participants included people aged 20 and above with a T1D diagnosis code (n = 3281) and a new prescription for insulin. Controls without diabetes were matched based on sex, year of birth, and practice. Cox regression analysis was conducted to estimate HRs for any fracture, major osteoporotic fractures (MOFs), and peripheral fractures (lower-arm and lower-leg) in people with T1D compared to controls. Risk factors for T1D were examined and included sex, age, diabetic complications, medication usage, Charlson comorbidity index (CCI), hypoglycemia, previous fractures, falls, and alcohol consumption. Furthermore, T1D was stratified by duration of disease and presence of microvascular complications. RESULTS: The proportion of any fracture was higher in T1D (10.8 %) than controls (7.3). Fully adjusted HRs for any fracture (1.43, CI95%: 1.17-1.74), MOFs (1.46, CI95%: 1.04-2.05), and lower-leg fractures (1.37, CI95%: 1.01-1.85) were statistically significantly increased in people with T1D compared to controls. The primary risk factor across all fracture sites in T1D was a previous fracture. Additional risk factors at different sites included previous falls (1.64, CI95%: 1.17-2.31), antidepressant use (1.34, CI95%: 1.02-1.76), and anxiolytic use (1.54, CI95%: 1.08-2.29) for any fracture; being female (1.65, CI95%: 1.14-2.38) for MOFs; the presence of retinopathy (1.47, CI95%: 1.02-2.11) and previous falls (2.04, CI95%: 1.16-3.59) for lower-arm and lower-leg fractures, respectively. Lipid-lowering medication use decreased the risk of MOFs (0.66, CI95%: 0.44-0.99). Stratification of T1D by disease duration showed that the relative risk of any fracture in T1D did not increase with longer diabetes duration (0-4 years: 1.52, CI95%: 1.23-1.87; 5-9 years: 1.30, CI95%: 0.99-1.71; <10 years: 1.07, CI95%: 0.74-1.55). Similar patterns were observed for other fracture sites. Moreover, the occurrence of microvascular complications in T1D was linked to a heightened risk of fractures in comparison to controls. However, when considering the T1D cohort independently, the association was not statistically significant. CONCLUSION: In a cohort of relatively healthy and newly diagnosed people with T1D HRs for any fracture, MOFs, and lower-leg fractures compared to controls were increased. A previous fracture was the most consistent risk factor for a subsequent fracture, whereas retinopathy was the only diabetes related one. We postulate a potential initial fracture risk, succeeded by a subsequent risk reduction, which might potentially increase in later years due to the accumulation of complications and other factors. |
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| ジャーナル名 | Bone |
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| 投稿日 | 2023/11/26 |
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| 投稿者 | Rasmussen, Nicklas H; Driessen, Johanna H M; Kvist, Annika Vestergaard; Souverein, Patrick C; van den Bergh, Joop; Vestergaard, Peter |
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| 組織名 | Steno Diabetes Center North Denmark, Aalborg University Hospital, Denmark.;Electronic address: Nicklas.rasmussen@rn.dk.;NUTRIM Research School, Maastricht University, Maastricht, the Netherlands;;Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute for;Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands; Department;of Clinical Pharmacy and Toxicology, Maastricht University Medical Centre+,;Maastricht, the Netherlands; Cardiovascular Research Institute Maastricht;(CARIM), Maastricht University, Maastricht, the Netherlands.;Department of Endocrinology and Metabolism, Molecular Endocrinology & Stem Cell;Research Unit (KMEB), Odense University Hospital, Odense, Denmark; University of;Southern Denmark, Odense, Denmark; Steno Diabetes Center North Denmark, Aalborg;University Hospital, Aalborg, Denmark; Institute of Pharmaceutical Sciences,;Department of Chemistry and Applied Biosciences, ETH-Zurich, Zurich, Switzerland.;Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands.;School for Nutrition and Translational Research in Metabolism (NUTRIM),;Maastricht University, Maastricht, the Netherlands; Department of Internal;Medicine, Division of Rheumatology, Maastricht University Medical Center+,;Maastricht, the Netherlands; Department of Internal Medicine, VieCuri Medical;Center, Venlo, the Netherlands.;Steno Diabetes Center North Denmark, Aalborg University Hospital, Denmark;;Department of Clinical Medicine and Endocrinology, Aalborg University Hospital,;Aalborg, Denmark. |
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| Pubmed リンク | https://www.ncbi.nlm.nih.gov/pubmed/38006906/ |
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