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Original Investigation
July 25, 2005

Nontraumatic Fracture Risk With Diabetes Mellitus and Impaired Fasting Glucose in Older White and Black Adults: The Health, Aging, and Body Composition Study

Author Affiliations

Author Affiliations: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pa (Drs Strotmeyer and Cauley); Departments of Epidemiology and Biostatistics (Drs Schwartz and Nevitt) and Medicine (Dr Bauer), University of California, San Francisco; Department of Epidemiology and Statistics, MedStar Research Institute, Hyattsville, Md (Dr Resnick); Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis (Dr Tylavsky); Laboratory of Epidemiology, Demography and Biometry, National Institute on Aging, Bethesda (Drs de Rekeneire and Harris); Department of Epidemiology and Division of Geriatric Medicine, University of Pittsburgh School of Medicine and School of Public Health, Pittsburgh (Dr Newman).

Arch Intern Med. 2005;165(14):1612-1617. doi:10.1001/archinte.165.14.1612

Background  Diabetes mellitus (DM) and related complications may increase clinical fracture risk in older adults.

Methods  Our objectives were to determine if type 2 diabetes mellitus or impaired fasting glucose was associated with higher fracture rates in older adults and to evaluate how diabetic individuals with fractures differed from those without fractures. The Health, Aging, and Body Composition Study participants were well-functioning, community-dwelling men and women aged 70 to 79 years (N = 2979; 42% black), of whom 19% had DM and 6% had impaired fasting glucose at baseline. Incident nontraumatic clinical fractures were verified by radiology reports for a mean ± SD of 4.5 ± 1.1 years. Cox proportional hazards regression models determined how DM and impaired fasting glucose affected subsequent risk of fracture.

Results  Diabetes mellitus was associated with elevated fracture risk (relative risk, 1.64; 95% confidence interval, 1.07-2.51) after adjustment for a hip bone mineral density (BMD) and fracture risk factors. Impaired fasting glucose was not significantly associated with fractures (relative risk, 1.34; 95% confidence interval, 0.67-2.67). Diabetic participants with fractures had lower hip BMD (0.818 g/cm2 vs 0.967 g/cm2; P<.001) and lean mass (44.3 kg vs 51.7 kg) and were more likely to have reduced peripheral sensation (35% vs 14%), transient ischemic attack/stroke (20% vs 8%), a lower physical performance battery score (5.0 vs 7.0), and falls (37% vs 21%) compared with diabetic participants without fractures (P<.05).

Conclusions  These results indicate that older white and black adults with DM are at higher fracture risk compared with nondiabetic adults with a similar BMD since a higher risk of nontraumatic fractures was found after adjustment for hip BMD. Fracture prevention needs to target specific risk factors found in older adults with DM.