Vertebral fractures in individuals with type 2 diabetes: More than skeletal complications alone

Fjorda Koromani; Ling Oei; Enisa Shevroja; Katerina Trajanoska; Josje Schoufour; Taulant Muka; Oscar H. Franco; M. Arfan Ikram; M. Carola Zillikens; André G. Uitterlinden; Gabriel P. Krestin; Tassos Anastassiades; Robert Josse; Stephanie M. Kaiser; David Goltzman; Brian C. Lentle; Jerilynn C. Prior; William D. Leslie; Eugene McCloskey; Olivier Lamy; Didier Hans; Edwin H. Oei; Fernando Rivadeneira

doi:10.2337/dc19-0925

Vertebral fractures in individuals with type 2 diabetes: More than skeletal complications alone

Fjorda Koromani, Ling Oei, Enisa Shevroja, Katerina Trajanoska, Josje Schoufour, Taulant Muka, Oscar H. Franco, M. Arfan Ikram, M. Carola Zillikens, André G. Uitterlinden, Gabriel P. Krestin, Tassos Anastassiades, Robert Josse, Stephanie M. Kaiser, David Goltzman, Brian C. Lentle, Jerilynn C. Prior, William D. Leslie, Eugene McCloskey, Olivier LamyDidier Hans, Edwin H. Oei, Fernando Rivadeneira

Medicine

Résultat de recherche: Article › examen par les pairs

111 Citations (Scopus)

Résumé

OBJECTIVE We aimed to assess whether individuals with type 2 diabetes (T2D) have increased risk of vertebral fractures (VFs) and to estimate nonvertebral fracture and mortality risk among individuals with both prevalent T2D and VFs. RESEARCH DESIGN AND METHODS A systematic PubMed search was performed to identify studies that investigated the relationship between T2D and VFs. Cohorts providing individual participant data (IPD) were also included. Estimates from published summary data and IPD cohorts were pooled in a random-effects meta-analysis. Multivariate Cox regression models were used to estimate nonvertebral fracture and mortality risk among individuals with T2D and VFs. RESULTS Across 15 studies comprising 852,705 men and women, individuals with T2D had lower risk of prevalent (odds ratio [OR] 0.84 [95% CI 0.74-0.95]; I² 5 0.0%; P_het 5 0.54) but increased risk of incident VFs (OR 1.35 [95% CI 1.27-1.44]; I² 5 0.6%; P_het 5 0.43). In the IPD cohorts (N 5 19,820), risk of nonvertebral fractures was higher in those with both T2D and VFs compared with those without T2D or VFs (hazard ratio [HR] 2.42 [95% CI 1.86-3.15]) or with VFs (HR 1.73 [95% CI 1.32-2.27]) or T2D (HR 1.94 [95% CI 1.46-2.59]) alone. Individuals with both T2D and VFs had increased mortality compared with individuals without T2D and VFs (HR 2.11 [95% CI 1.72-2.59]) or with VFs alone (HR 1.84 [95% CI 1.49-2.28]) and borderline increased compared with individuals with T2D alone (HR 1.23 [95% CI 0.99-1.52]). CONCLUSIONS Based on our findings, individuals with T2D should be systematically assessed for presence of VFs, and, as in individuals without T2D, their presence constitutes an indication to start osteoporosis treatment for the prevention of future fractures.

Langue d'origine	English
Pages (de-à)	137-144
Nombre de pages	8
Journal	Diabetes Care
Volume	43
Numéro de publication	1
DOI	https://doi.org/10.2337/dc19-0925
Statut de publication	Published - janv. 1 2020

Note bibliographique

Funding Information:
Acknowledgments. The authors thank the individuals of all cohorts for their cooperation, the dedicated research team that is conducting the studies, employees from Optasia Medical Ltd. who familiarized us with the use of the Spine- Analyzer software, the study individuals, and the staff from the Rotterdam Study (particularly Hannie van den Boogert for acquisition of the radiographs and DXA measurements) and the participating general practitioners and pharmacists. The authors also thank René Vermeren (Erasmus University Medical Center, Rotterdam, the Netherlands), Nano Suwarno (Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands), and Mart Rentmeester (Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands) for technical support and the team of radiographic readers for the tremendous efforts. The authors thank Marie Almudena Metzger (Bone and Joint Department, Center of Bone Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland), the principal research nurse of the OsteoLaus cohort, who made considerable contributions to the collection of the data, as well as our DXA technologists and Claudie Berger (CaMos National Coordinating Centre, McGill University, Montreal, Quebec, Canada) for the excellent statistical and data management work over this period of time. Funding. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, The Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (014-93-015, RIDE2), the Ministry of Education, Cul-tureandScience,theMinistryforHealth,Welfare and Sports, the European Commission (Directorate-General XII), and the Municipality of Rotterdam. F.K. and F.R. are funded by the Netherlands Scientific Organization and ZonMW project number NWO/ZONMW-VIDI-016-136-367. The Study of Osteoporotic Fractures is supported by National Institutes of Health funding. The National Institute on Aging provides support under the following grants: R01-AG-005407, R01-AR-35582, R01-AR-35583, R01-AR-35584, R01-AG-005394, R01-AG-027574, and R01-AG-027576. The OsteoLaus study was and is supported by research grants from Lausanne University Hospital (Strategic plan funds) and the Swiss National Science Foundation (grant 32473B_156978). The Canadian Multicentre Osteoporosis Study has been funded by the Canadian Institutes of Health Research and various other not-for-profit or pharmaceutical agencies from 1994 to 2017.

Funding Information:
The funding sources had no role in the study design, data collection, analysis, and interpretation, writing of the report, or decision to submit the article for publication. Duality of Interest. M.C.Z. has received in the pastfeeforlecturesand/oradvicefromAmgen,Eli LillyandCompany,Merck,andUCBPharma.G.P.K. performs consulting activities with Bracco Imaging and has received institutional research grants from Siemens Healthineers, GE Healthcare, and Bayer AG. D.H. is co-owner of the TBS patent and has corresponding ownership shares and a position at Medimaps. No other potential conflicts of interest relevant to this article were reported. Author Contributions. F.K. contributed to the literature search, data analysis, data interpretation, and prepared the first draft. F.K., L.O., E.S., K.T.,J.S.,T.M.,O.H.F.,M.A.I.,M.C.Z.,A.G.U.,G.P.K., T.A., R.J., S.M.K., D.G., B.C.L., J.C.P., W.D.L., E.M., O.L., D.H., E.H.O., and F.R. contributed to data collection, study design, and data interpretation and critically reviewed the report. F.K. and F.R. are the guarantors of this work and, as such, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Funding Information:
The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, The Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (014-93-015, RIDE2), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (Directorate-General XII), and the Municipality of Rotterdam. F.K. and F.R. are funded by the Netherlands Scientific Organization and ZonMW project number NWO/ZONMW-VIDI-016-136-367. The Study of Osteoporotic Fractures is supported by National Institutes of Health funding. The National Institute on Aging provides support under the following grants: R01-AG-005407, R01-AR-35582, R01-AR-35583, R01-AR-35584, R01-AG-005394, R01-AG-027574, and R01-AG-027576. The OsteoLaus study was and is supported by research grants from Lausanne University Hospital (Strategic plan funds) and the Swiss National Science Foundation (grant 32473B_156978). The Canadian Multicentre Osteoporosis Study has been funded by the Canadian Institutes of Health Research and various other not-for-profit or pharmaceutical agencies from 1994 to 2017. The funding sources had no role in the study design, data collection, analysis, and interpretation, writing of the report, or decision to submit the article for publication.

Publisher Copyright:
© 2019 by the American Diabetes Association.

ASJC Scopus Subject Areas

Internal Medicine
Endocrinology, Diabetes and Metabolism
Advanced and Specialised Nursing

ODD de l’ONU

Cette action contribue à la réalisation des objectifs de développement durable suivants

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10.2337/dc19-0925

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Citer

Koromani, F., Oei, L., Shevroja, E., Trajanoska, K., Schoufour, J., Muka, T., Franco, O. H., Arfan Ikram, M., Carola Zillikens, M., Uitterlinden, A. G., Krestin, G. P., Anastassiades, T., Josse, R., Kaiser, S. M., Goltzman, D., Lentle, B. C., Prior, J. C., Leslie, W. D., McCloskey, E., ... Rivadeneira, F. (2020). Vertebral fractures in individuals with type 2 diabetes: More than skeletal complications alone. Diabetes Care, 43(1), 137-144. https://doi.org/10.2337/dc19-0925

Koromani, F, Oei, L, Shevroja, E, Trajanoska, K, Schoufour, J, Muka, T, Franco, OH, Arfan Ikram, M, Carola Zillikens, M, Uitterlinden, AG, Krestin, GP, Anastassiades, T, Josse, R, Kaiser, SM, Goltzman, D, Lentle, BC, Prior, JC, Leslie, WD, McCloskey, E, Lamy, O, Hans, D, Oei, EH & Rivadeneira, F 2020, 'Vertebral fractures in individuals with type 2 diabetes: More than skeletal complications alone', Diabetes Care, vol. 43, n° 1, pp. 137-144. https://doi.org/10.2337/dc19-0925

@article{155d76d4dcd24914b71f472952bbb196,

title = "Vertebral fractures in individuals with type 2 diabetes: More than skeletal complications alone",

abstract = "OBJECTIVE We aimed to assess whether individuals with type 2 diabetes (T2D) have increased risk of vertebral fractures (VFs) and to estimate nonvertebral fracture and mortality risk among individuals with both prevalent T2D and VFs. RESEARCH DESIGN AND METHODS A systematic PubMed search was performed to identify studies that investigated the relationship between T2D and VFs. Cohorts providing individual participant data (IPD) were also included. Estimates from published summary data and IPD cohorts were pooled in a random-effects meta-analysis. Multivariate Cox regression models were used to estimate nonvertebral fracture and mortality risk among individuals with T2D and VFs. RESULTS Across 15 studies comprising 852,705 men and women, individuals with T2D had lower risk of prevalent (odds ratio [OR] 0.84 [95% CI 0.74-0.95]; I2 5 0.0%; Phet 5 0.54) but increased risk of incident VFs (OR 1.35 [95% CI 1.27-1.44]; I2 5 0.6%; Phet 5 0.43). In the IPD cohorts (N 5 19,820), risk of nonvertebral fractures was higher in those with both T2D and VFs compared with those without T2D or VFs (hazard ratio [HR] 2.42 [95% CI 1.86-3.15]) or with VFs (HR 1.73 [95% CI 1.32-2.27]) or T2D (HR 1.94 [95% CI 1.46-2.59]) alone. Individuals with both T2D and VFs had increased mortality compared with individuals without T2D and VFs (HR 2.11 [95% CI 1.72-2.59]) or with VFs alone (HR 1.84 [95% CI 1.49-2.28]) and borderline increased compared with individuals with T2D alone (HR 1.23 [95% CI 0.99-1.52]). CONCLUSIONS Based on our findings, individuals with T2D should be systematically assessed for presence of VFs, and, as in individuals without T2D, their presence constitutes an indication to start osteoporosis treatment for the prevention of future fractures.",

author = "Fjorda Koromani and Ling Oei and Enisa Shevroja and Katerina Trajanoska and Josje Schoufour and Taulant Muka and Franco, {Oscar H.} and {Arfan Ikram}, M. and {Carola Zillikens}, M. and Uitterlinden, {Andr{\'e} G.} and Krestin, {Gabriel P.} and Tassos Anastassiades and Robert Josse and Kaiser, {Stephanie M.} and David Goltzman and Lentle, {Brian C.} and Prior, {Jerilynn C.} and Leslie, {William D.} and Eugene McCloskey and Olivier Lamy and Didier Hans and Oei, {Edwin H.} and Fernando Rivadeneira",

note = "Funding Information: Acknowledgments. The authors thank the individuals of all cohorts for their cooperation, the dedicated research team that is conducting the studies, employees from Optasia Medical Ltd. who familiarized us with the use of the Spine- Analyzer software, the study individuals, and the staff from the Rotterdam Study (particularly Hannie van den Boogert for acquisition of the radiographs and DXA measurements) and the participating general practitioners and pharmacists. The authors also thank Ren{\'e} Vermeren (Erasmus University Medical Center, Rotterdam, the Netherlands), Nano Suwarno (Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands), and Mart Rentmeester (Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands) for technical support and the team of radiographic readers for the tremendous efforts. The authors thank Marie Almudena Metzger (Bone and Joint Department, Center of Bone Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland), the principal research nurse of the OsteoLaus cohort, who made considerable contributions to the collection of the data, as well as our DXA technologists and Claudie Berger (CaMos National Coordinating Centre, McGill University, Montreal, Quebec, Canada) for the excellent statistical and data management work over this period of time. Funding. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, The Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (014-93-015, RIDE2), the Ministry of Education, Cul-tureandScience,theMinistryforHealth,Welfare and Sports, the European Commission (Directorate-General XII), and the Municipality of Rotterdam. F.K. and F.R. are funded by the Netherlands Scientific Organization and ZonMW project number NWO/ZONMW-VIDI-016-136-367. The Study of Osteoporotic Fractures is supported by National Institutes of Health funding. The National Institute on Aging provides support under the following grants: R01-AG-005407, R01-AR-35582, R01-AR-35583, R01-AR-35584, R01-AG-005394, R01-AG-027574, and R01-AG-027576. The OsteoLaus study was and is supported by research grants from Lausanne University Hospital (Strategic plan funds) and the Swiss National Science Foundation (grant 32473B_156978). The Canadian Multicentre Osteoporosis Study has been funded by the Canadian Institutes of Health Research and various other not-for-profit or pharmaceutical agencies from 1994 to 2017. Funding Information: The funding sources had no role in the study design, data collection, analysis, and interpretation, writing of the report, or decision to submit the article for publication. Duality of Interest. M.C.Z. has received in the pastfeeforlecturesand/oradvicefromAmgen,Eli LillyandCompany,Merck,andUCBPharma.G.P.K. performs consulting activities with Bracco Imaging and has received institutional research grants from Siemens Healthineers, GE Healthcare, and Bayer AG. D.H. is co-owner of the TBS patent and has corresponding ownership shares and a position at Medimaps. No other potential conflicts of interest relevant to this article were reported. Author Contributions. F.K. contributed to the literature search, data analysis, data interpretation, and prepared the first draft. F.K., L.O., E.S., K.T.,J.S.,T.M.,O.H.F.,M.A.I.,M.C.Z.,A.G.U.,G.P.K., T.A., R.J., S.M.K., D.G., B.C.L., J.C.P., W.D.L., E.M., O.L., D.H., E.H.O., and F.R. contributed to data collection, study design, and data interpretation and critically reviewed the report. F.K. and F.R. are the guarantors of this work and, as such, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, The Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (014-93-015, RIDE2), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (Directorate-General XII), and the Municipality of Rotterdam. F.K. and F.R. are funded by the Netherlands Scientific Organization and ZonMW project number NWO/ZONMW-VIDI-016-136-367. The Study of Osteoporotic Fractures is supported by National Institutes of Health funding. The National Institute on Aging provides support under the following grants: R01-AG-005407, R01-AR-35582, R01-AR-35583, R01-AR-35584, R01-AG-005394, R01-AG-027574, and R01-AG-027576. The OsteoLaus study was and is supported by research grants from Lausanne University Hospital (Strategic plan funds) and the Swiss National Science Foundation (grant 32473B_156978). The Canadian Multicentre Osteoporosis Study has been funded by the Canadian Institutes of Health Research and various other not-for-profit or pharmaceutical agencies from 1994 to 2017. The funding sources had no role in the study design, data collection, analysis, and interpretation, writing of the report, or decision to submit the article for publication. Publisher Copyright: {\textcopyright} 2019 by the American Diabetes Association.",

year = "2020",

month = jan,

day = "1",

doi = "10.2337/dc19-0925",

language = "English",

volume = "43",

pages = "137--144",

journal = "Diabetes Care",

issn = "0149-5992",

publisher = "American Diabetes Association Inc.",

number = "1",

}

TY - JOUR

T1 - Vertebral fractures in individuals with type 2 diabetes

T2 - More than skeletal complications alone

AU - Koromani, Fjorda

AU - Oei, Ling

AU - Shevroja, Enisa

AU - Trajanoska, Katerina

AU - Schoufour, Josje

AU - Muka, Taulant

AU - Franco, Oscar H.

AU - Arfan Ikram, M.

AU - Carola Zillikens, M.

AU - Uitterlinden, André G.

AU - Krestin, Gabriel P.

AU - Anastassiades, Tassos

AU - Josse, Robert

AU - Kaiser, Stephanie M.

AU - Goltzman, David

AU - Lentle, Brian C.

AU - Prior, Jerilynn C.

AU - Leslie, William D.

AU - McCloskey, Eugene

AU - Lamy, Olivier

AU - Hans, Didier

AU - Oei, Edwin H.

AU - Rivadeneira, Fernando

N1 - Funding Information: Acknowledgments. The authors thank the individuals of all cohorts for their cooperation, the dedicated research team that is conducting the studies, employees from Optasia Medical Ltd. who familiarized us with the use of the Spine- Analyzer software, the study individuals, and the staff from the Rotterdam Study (particularly Hannie van den Boogert for acquisition of the radiographs and DXA measurements) and the participating general practitioners and pharmacists. The authors also thank René Vermeren (Erasmus University Medical Center, Rotterdam, the Netherlands), Nano Suwarno (Department of Epidemiology, Erasmus University Medical Center, Rotterdam, the Netherlands), and Mart Rentmeester (Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands) for technical support and the team of radiographic readers for the tremendous efforts. The authors thank Marie Almudena Metzger (Bone and Joint Department, Center of Bone Diseases, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland), the principal research nurse of the OsteoLaus cohort, who made considerable contributions to the collection of the data, as well as our DXA technologists and Claudie Berger (CaMos National Coordinating Centre, McGill University, Montreal, Quebec, Canada) for the excellent statistical and data management work over this period of time. Funding. The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, The Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (014-93-015, RIDE2), the Ministry of Education, Cul-tureandScience,theMinistryforHealth,Welfare and Sports, the European Commission (Directorate-General XII), and the Municipality of Rotterdam. F.K. and F.R. are funded by the Netherlands Scientific Organization and ZonMW project number NWO/ZONMW-VIDI-016-136-367. The Study of Osteoporotic Fractures is supported by National Institutes of Health funding. The National Institute on Aging provides support under the following grants: R01-AG-005407, R01-AR-35582, R01-AR-35583, R01-AR-35584, R01-AG-005394, R01-AG-027574, and R01-AG-027576. The OsteoLaus study was and is supported by research grants from Lausanne University Hospital (Strategic plan funds) and the Swiss National Science Foundation (grant 32473B_156978). The Canadian Multicentre Osteoporosis Study has been funded by the Canadian Institutes of Health Research and various other not-for-profit or pharmaceutical agencies from 1994 to 2017. Funding Information: The funding sources had no role in the study design, data collection, analysis, and interpretation, writing of the report, or decision to submit the article for publication. Duality of Interest. M.C.Z. has received in the pastfeeforlecturesand/oradvicefromAmgen,Eli LillyandCompany,Merck,andUCBPharma.G.P.K. performs consulting activities with Bracco Imaging and has received institutional research grants from Siemens Healthineers, GE Healthcare, and Bayer AG. D.H. is co-owner of the TBS patent and has corresponding ownership shares and a position at Medimaps. No other potential conflicts of interest relevant to this article were reported. Author Contributions. F.K. contributed to the literature search, data analysis, data interpretation, and prepared the first draft. F.K., L.O., E.S., K.T.,J.S.,T.M.,O.H.F.,M.A.I.,M.C.Z.,A.G.U.,G.P.K., T.A., R.J., S.M.K., D.G., B.C.L., J.C.P., W.D.L., E.M., O.L., D.H., E.H.O., and F.R. contributed to data collection, study design, and data interpretation and critically reviewed the report. F.K. and F.R. are the guarantors of this work and, as such, had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Funding Information: The Rotterdam Study is funded by Erasmus Medical Center and Erasmus University, The Netherlands Organization for the Health Research and Development (ZonMw), the Research Institute for Diseases in the Elderly (014-93-015, RIDE2), the Ministry of Education, Culture and Science, the Ministry for Health, Welfare and Sports, the European Commission (Directorate-General XII), and the Municipality of Rotterdam. F.K. and F.R. are funded by the Netherlands Scientific Organization and ZonMW project number NWO/ZONMW-VIDI-016-136-367. The Study of Osteoporotic Fractures is supported by National Institutes of Health funding. The National Institute on Aging provides support under the following grants: R01-AG-005407, R01-AR-35582, R01-AR-35583, R01-AR-35584, R01-AG-005394, R01-AG-027574, and R01-AG-027576. The OsteoLaus study was and is supported by research grants from Lausanne University Hospital (Strategic plan funds) and the Swiss National Science Foundation (grant 32473B_156978). The Canadian Multicentre Osteoporosis Study has been funded by the Canadian Institutes of Health Research and various other not-for-profit or pharmaceutical agencies from 1994 to 2017. The funding sources had no role in the study design, data collection, analysis, and interpretation, writing of the report, or decision to submit the article for publication. Publisher Copyright: © 2019 by the American Diabetes Association.

PY - 2020/1/1

Y1 - 2020/1/1

N2 - OBJECTIVE We aimed to assess whether individuals with type 2 diabetes (T2D) have increased risk of vertebral fractures (VFs) and to estimate nonvertebral fracture and mortality risk among individuals with both prevalent T2D and VFs. RESEARCH DESIGN AND METHODS A systematic PubMed search was performed to identify studies that investigated the relationship between T2D and VFs. Cohorts providing individual participant data (IPD) were also included. Estimates from published summary data and IPD cohorts were pooled in a random-effects meta-analysis. Multivariate Cox regression models were used to estimate nonvertebral fracture and mortality risk among individuals with T2D and VFs. RESULTS Across 15 studies comprising 852,705 men and women, individuals with T2D had lower risk of prevalent (odds ratio [OR] 0.84 [95% CI 0.74-0.95]; I2 5 0.0%; Phet 5 0.54) but increased risk of incident VFs (OR 1.35 [95% CI 1.27-1.44]; I2 5 0.6%; Phet 5 0.43). In the IPD cohorts (N 5 19,820), risk of nonvertebral fractures was higher in those with both T2D and VFs compared with those without T2D or VFs (hazard ratio [HR] 2.42 [95% CI 1.86-3.15]) or with VFs (HR 1.73 [95% CI 1.32-2.27]) or T2D (HR 1.94 [95% CI 1.46-2.59]) alone. Individuals with both T2D and VFs had increased mortality compared with individuals without T2D and VFs (HR 2.11 [95% CI 1.72-2.59]) or with VFs alone (HR 1.84 [95% CI 1.49-2.28]) and borderline increased compared with individuals with T2D alone (HR 1.23 [95% CI 0.99-1.52]). CONCLUSIONS Based on our findings, individuals with T2D should be systematically assessed for presence of VFs, and, as in individuals without T2D, their presence constitutes an indication to start osteoporosis treatment for the prevention of future fractures.

AB - OBJECTIVE We aimed to assess whether individuals with type 2 diabetes (T2D) have increased risk of vertebral fractures (VFs) and to estimate nonvertebral fracture and mortality risk among individuals with both prevalent T2D and VFs. RESEARCH DESIGN AND METHODS A systematic PubMed search was performed to identify studies that investigated the relationship between T2D and VFs. Cohorts providing individual participant data (IPD) were also included. Estimates from published summary data and IPD cohorts were pooled in a random-effects meta-analysis. Multivariate Cox regression models were used to estimate nonvertebral fracture and mortality risk among individuals with T2D and VFs. RESULTS Across 15 studies comprising 852,705 men and women, individuals with T2D had lower risk of prevalent (odds ratio [OR] 0.84 [95% CI 0.74-0.95]; I2 5 0.0%; Phet 5 0.54) but increased risk of incident VFs (OR 1.35 [95% CI 1.27-1.44]; I2 5 0.6%; Phet 5 0.43). In the IPD cohorts (N 5 19,820), risk of nonvertebral fractures was higher in those with both T2D and VFs compared with those without T2D or VFs (hazard ratio [HR] 2.42 [95% CI 1.86-3.15]) or with VFs (HR 1.73 [95% CI 1.32-2.27]) or T2D (HR 1.94 [95% CI 1.46-2.59]) alone. Individuals with both T2D and VFs had increased mortality compared with individuals without T2D and VFs (HR 2.11 [95% CI 1.72-2.59]) or with VFs alone (HR 1.84 [95% CI 1.49-2.28]) and borderline increased compared with individuals with T2D alone (HR 1.23 [95% CI 0.99-1.52]). CONCLUSIONS Based on our findings, individuals with T2D should be systematically assessed for presence of VFs, and, as in individuals without T2D, their presence constitutes an indication to start osteoporosis treatment for the prevention of future fractures.

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U2 - 10.2337/dc19-0925

DO - 10.2337/dc19-0925

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AN - SCOPUS:85077016879

SN - 0149-5992

VL - 43

SP - 137

EP - 144

JO - Diabetes Care

JF - Diabetes Care

IS - 1

ER -

Vertebral fractures in individuals with type 2 diabetes: More than skeletal complications alone

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