Diabetes and risk of fracture-related hospitalization

The atherosclerosis risk in communities study

Andrea L C Schneider, Emma K. Williams, Frederick L. Brancati, Saul Blecker, Josef Coresh, Elizabeth Selvin

Research output: Contribution to journalArticle

Abstract

OBJECTIVE-To examine the association between diabetes, glycemic control, and risk of fracture-related hospitalization in the Atherosclerosis Risk in Communities (ARIC) Study. RESEARCH DESIGN AND METHODS-Fracture-related hospitalization was defined using International Classification of Diseases, 9th revision, codes (733.1-733.19, 733.93- 733.98, or 800-829). We calculated the incidence rate of fracture-related hospitalization by age and used Cox proportional hazards models to investigate the association of diabetes with risk of fracture after adjustment for demographic, lifestyle, and behavioral risk factors. RESULTS-There were 1,078 incident fracture-related hospitalizations among 15,140 participants during a median of 20 years of follow-up. The overall incidence rate was 4.0 per 1,000 person-years (95% confidence interval [CI], 3.8-4.3). Diagnosed diabetes was significantly and independently associated with an increased risk of fracture (adjusted hazard ratio [HR], 1.74; 95% CI, 1.42-2.14). There also was a significantly increased risk of fracture among persons with diagnosed diabetes who were treated with insulin (HR, 1.87; 95% CI, 1.15-3.05) and among persons with diagnosed diabetes with hemoglobin A 1c (HbA1c) ≥8% (1.63; 1.09-2.44) compared with those with HbA1c <8%. Undiagnosed diabetes was not significantly associated with risk of fracture (HR, 1.12; 95% CI, 0.82-1.53). CONCLUSIONS-This study supports recommendations from the American Diabetes Association for assessment of fracture risk and implementation of prevention strategies in persons with type 2 diabetes, particularly those persons with poor glucose control.

Original languageEnglish (US)
Pages (from-to)1153-1158
Number of pages6
JournalDiabetes Care
Volume36
Issue number5
DOIs
StatePublished - 2013

Fingerprint

Atherosclerosis
Hospitalization
Confidence Intervals
Hemoglobin A
Incidence
International Classification of Diseases
Proportional Hazards Models
Type 2 Diabetes Mellitus
Life Style
Research Design
Demography
Insulin
Glucose

ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Advanced and Specialized Nursing
  • Medicine(all)

Cite this

Diabetes and risk of fracture-related hospitalization : The atherosclerosis risk in communities study. / Schneider, Andrea L C; Williams, Emma K.; Brancati, Frederick L.; Blecker, Saul; Coresh, Josef; Selvin, Elizabeth.

In: Diabetes Care, Vol. 36, No. 5, 2013, p. 1153-1158.

Research output: Contribution to journalArticle

Schneider, Andrea L C ; Williams, Emma K. ; Brancati, Frederick L. ; Blecker, Saul ; Coresh, Josef ; Selvin, Elizabeth. / Diabetes and risk of fracture-related hospitalization : The atherosclerosis risk in communities study. In: Diabetes Care. 2013 ; Vol. 36, No. 5. pp. 1153-1158.
@article{fe2340c9475445749de79a4d413e7a21,
title = "Diabetes and risk of fracture-related hospitalization: The atherosclerosis risk in communities study",
abstract = "OBJECTIVE-To examine the association between diabetes, glycemic control, and risk of fracture-related hospitalization in the Atherosclerosis Risk in Communities (ARIC) Study. RESEARCH DESIGN AND METHODS-Fracture-related hospitalization was defined using International Classification of Diseases, 9th revision, codes (733.1-733.19, 733.93- 733.98, or 800-829). We calculated the incidence rate of fracture-related hospitalization by age and used Cox proportional hazards models to investigate the association of diabetes with risk of fracture after adjustment for demographic, lifestyle, and behavioral risk factors. RESULTS-There were 1,078 incident fracture-related hospitalizations among 15,140 participants during a median of 20 years of follow-up. The overall incidence rate was 4.0 per 1,000 person-years (95{\%} confidence interval [CI], 3.8-4.3). Diagnosed diabetes was significantly and independently associated with an increased risk of fracture (adjusted hazard ratio [HR], 1.74; 95{\%} CI, 1.42-2.14). There also was a significantly increased risk of fracture among persons with diagnosed diabetes who were treated with insulin (HR, 1.87; 95{\%} CI, 1.15-3.05) and among persons with diagnosed diabetes with hemoglobin A 1c (HbA1c) ≥8{\%} (1.63; 1.09-2.44) compared with those with HbA1c <8{\%}. Undiagnosed diabetes was not significantly associated with risk of fracture (HR, 1.12; 95{\%} CI, 0.82-1.53). CONCLUSIONS-This study supports recommendations from the American Diabetes Association for assessment of fracture risk and implementation of prevention strategies in persons with type 2 diabetes, particularly those persons with poor glucose control.",
author = "Schneider, {Andrea L C} and Williams, {Emma K.} and Brancati, {Frederick L.} and Saul Blecker and Josef Coresh and Elizabeth Selvin",
year = "2013",
doi = "10.2337/dc12-1168",
language = "English (US)",
volume = "36",
pages = "1153--1158",
journal = "Diabetes Care",
issn = "1935-5548",
publisher = "American Diabetes Association Inc.",
number = "5",

}

TY - JOUR

T1 - Diabetes and risk of fracture-related hospitalization

T2 - The atherosclerosis risk in communities study

AU - Schneider, Andrea L C

AU - Williams, Emma K.

AU - Brancati, Frederick L.

AU - Blecker, Saul

AU - Coresh, Josef

AU - Selvin, Elizabeth

PY - 2013

Y1 - 2013

N2 - OBJECTIVE-To examine the association between diabetes, glycemic control, and risk of fracture-related hospitalization in the Atherosclerosis Risk in Communities (ARIC) Study. RESEARCH DESIGN AND METHODS-Fracture-related hospitalization was defined using International Classification of Diseases, 9th revision, codes (733.1-733.19, 733.93- 733.98, or 800-829). We calculated the incidence rate of fracture-related hospitalization by age and used Cox proportional hazards models to investigate the association of diabetes with risk of fracture after adjustment for demographic, lifestyle, and behavioral risk factors. RESULTS-There were 1,078 incident fracture-related hospitalizations among 15,140 participants during a median of 20 years of follow-up. The overall incidence rate was 4.0 per 1,000 person-years (95% confidence interval [CI], 3.8-4.3). Diagnosed diabetes was significantly and independently associated with an increased risk of fracture (adjusted hazard ratio [HR], 1.74; 95% CI, 1.42-2.14). There also was a significantly increased risk of fracture among persons with diagnosed diabetes who were treated with insulin (HR, 1.87; 95% CI, 1.15-3.05) and among persons with diagnosed diabetes with hemoglobin A 1c (HbA1c) ≥8% (1.63; 1.09-2.44) compared with those with HbA1c <8%. Undiagnosed diabetes was not significantly associated with risk of fracture (HR, 1.12; 95% CI, 0.82-1.53). CONCLUSIONS-This study supports recommendations from the American Diabetes Association for assessment of fracture risk and implementation of prevention strategies in persons with type 2 diabetes, particularly those persons with poor glucose control.

AB - OBJECTIVE-To examine the association between diabetes, glycemic control, and risk of fracture-related hospitalization in the Atherosclerosis Risk in Communities (ARIC) Study. RESEARCH DESIGN AND METHODS-Fracture-related hospitalization was defined using International Classification of Diseases, 9th revision, codes (733.1-733.19, 733.93- 733.98, or 800-829). We calculated the incidence rate of fracture-related hospitalization by age and used Cox proportional hazards models to investigate the association of diabetes with risk of fracture after adjustment for demographic, lifestyle, and behavioral risk factors. RESULTS-There were 1,078 incident fracture-related hospitalizations among 15,140 participants during a median of 20 years of follow-up. The overall incidence rate was 4.0 per 1,000 person-years (95% confidence interval [CI], 3.8-4.3). Diagnosed diabetes was significantly and independently associated with an increased risk of fracture (adjusted hazard ratio [HR], 1.74; 95% CI, 1.42-2.14). There also was a significantly increased risk of fracture among persons with diagnosed diabetes who were treated with insulin (HR, 1.87; 95% CI, 1.15-3.05) and among persons with diagnosed diabetes with hemoglobin A 1c (HbA1c) ≥8% (1.63; 1.09-2.44) compared with those with HbA1c <8%. Undiagnosed diabetes was not significantly associated with risk of fracture (HR, 1.12; 95% CI, 0.82-1.53). CONCLUSIONS-This study supports recommendations from the American Diabetes Association for assessment of fracture risk and implementation of prevention strategies in persons with type 2 diabetes, particularly those persons with poor glucose control.

UR - http://www.scopus.com/inward/record.url?scp=84876785267&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84876785267&partnerID=8YFLogxK

U2 - 10.2337/dc12-1168

DO - 10.2337/dc12-1168

M3 - Article

VL - 36

SP - 1153

EP - 1158

JO - Diabetes Care

JF - Diabetes Care

SN - 1935-5548

IS - 5

ER -