Insulin use and Excess Fracture Risk in Patients with Type 2 Diabetes: A Propensity-Matched cohort analysis
Despite normal to high bone mineral density, patients with type 2 diabetes (T2DM) have an increased fracture risk. T2DM medications could partially account for this excess risk. The aim of this study was to assess the association between insulin use and bone fracture risk in T2DM patients. A populat...
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| Published in: | Scientific reports Vol. 7; no. 1; pp. 3781 - 9 |
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| Abstract | Despite normal to high bone mineral density, patients with type 2 diabetes (T2DM) have an increased fracture risk. T2DM medications could partially account for this excess risk. The aim of this study was to assess the association between insulin use and bone fracture risk in T2DM patients. A population-based matched cohort study based on a primary care records database validated for research use (Catalonia, Spain) was performed. Propensity score (PS) for insulin use was calculated using logistic regression including predefined predictors of fractures. A total of 2,979 insulin users and 14,895 non-users were observed for a median of 1.42 and 4.58 years respectively. Major fracture rates were 11.2/1,000 person-years for insulin users, compared with 8.3/1,000 among non-users. Matched models confirmed a significant association, with an adjusted subhazard ratio (adj SHR) of 1.38 [95% CI 1.06 to 1.80] for major fractures. No differences between types of insulin or different regimens were found. Estimated number needed to harm (fracture) was 82 (95% CI 32 to 416). Insulin use appears to be associated with a 38% excess fracture risk among T2DM patients in the early stages of the disease. Fracture risk should be included among the considerations to initiate insulin treatment. |
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| AbstractList | Despite normal to high bone mineral density, patients with type 2 diabetes (T2DM) have an increased fracture risk. T2DM medications could partially account for this excess risk. The aim of this study was to assess the association between insulin use and bone fracture risk in T2DM patients. A population-based matched cohort study based on a primary care records database validated for research use (Catalonia, Spain) was performed. Propensity score (PS) for insulin use was calculated using logistic regression including predefined predictors of fractures. A total of 2,979 insulin users and 14,895 non-users were observed for a median of 1.42 and 4.58 years respectively. Major fracture rates were 11.2/1,000 person-years for insulin users, compared with 8.3/1,000 among non-users. Matched models confirmed a significant association, with an adjusted subhazard ratio (adj SHR) of 1.38 [95% CI 1.06 to 1.80] for major fractures. No differences between types of insulin or different regimens were found. Estimated number needed to harm (fracture) was 82 (95% CI 32 to 416). Insulin use appears to be associated with a 38% excess fracture risk among T2DM patients in the early stages of the disease. Fracture risk should be included among the considerations to initiate insulin treatment. Abstract Despite normal to high bone mineral density, patients with type 2 diabetes (T2DM) have an increased fracture risk. T2DM medications could partially account for this excess risk. The aim of this study was to assess the association between insulin use and bone fracture risk in T2DM patients. A population-based matched cohort study based on a primary care records database validated for research use (Catalonia, Spain) was performed. Propensity score (PS) for insulin use was calculated using logistic regression including predefined predictors of fractures. A total of 2,979 insulin users and 14,895 non-users were observed for a median of 1.42 and 4.58 years respectively. Major fracture rates were 11.2/1,000 person-years for insulin users, compared with 8.3/1,000 among non-users. Matched models confirmed a significant association, with an adjusted subhazard ratio (adj SHR) of 1.38 [95% CI 1.06 to 1.80] for major fractures. No differences between types of insulin or different regimens were found. Estimated number needed to harm (fracture) was 82 (95% CI 32 to 416). Insulin use appears to be associated with a 38% excess fracture risk among T2DM patients in the early stages of the disease. Fracture risk should be included among the considerations to initiate insulin treatment. |
| ArticleNumber | 3781 |
| Author | Prieto-Alhambra, Daniel Soldevila, Berta Nogues, Xavier Martinez-Laguna, Daniel Diez-Perez, Adolfo Losada-Grande, Eladio Hawley, Samuel Puig-Domingo, Manel Mauricio, Dídac |
| Author_xml | – sequence: 1 givenname: Eladio surname: Losada-Grande fullname: Losada-Grande, Eladio organization: Department of Medicine, Autonomous University of Barcelona, Endocrinology Section, Internal Medicine Department, Hospital Can Misses – sequence: 2 givenname: Samuel surname: Hawley fullname: Hawley, Samuel organization: Musculoskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford – sequence: 3 givenname: Berta surname: Soldevila fullname: Soldevila, Berta organization: Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute “Germans Trias i Pujol”, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III – sequence: 4 givenname: Daniel surname: Martinez-Laguna fullname: Martinez-Laguna, Daniel organization: GREMPAL Research Group, IDIAP Jordi Gol Primary Care Research Institute, Autonomous University of Barcelona, CIBER of Healthy Ageing and Frailty Research (CIBERFes), Instituto de Salud Carlos III – sequence: 5 givenname: Xavier surname: Nogues fullname: Nogues, Xavier organization: Internal Medicine Department, IMIM (Hospital del Mar Research Institute), Autonomous University of Barcelona, CIBER of Healthy Ageing and Frailty Research (CIBERFes), Instituto de Salud Carlos III – sequence: 6 givenname: Adolfo surname: Diez-Perez fullname: Diez-Perez, Adolfo organization: Internal Medicine Department, IMIM (Hospital del Mar Research Institute), Autonomous University of Barcelona, CIBER of Healthy Ageing and Frailty Research (CIBERFes), Instituto de Salud Carlos III – sequence: 7 givenname: Manel surname: Puig-Domingo fullname: Puig-Domingo, Manel organization: Department of Medicine, Autonomous University of Barcelona, Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute “Germans Trias i Pujol”, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III – sequence: 8 givenname: Dídac surname: Mauricio fullname: Mauricio, Dídac email: didacmauricio@gmail.com organization: Department of Endocrinology and Nutrition, University Hospital & Health Sciences Research Institute “Germans Trias i Pujol”, CIBER of Diabetes and Associated Metabolic Diseases (CIBERDEM), Instituto de Salud Carlos III – sequence: 9 givenname: Daniel surname: Prieto-Alhambra fullname: Prieto-Alhambra, Daniel organization: Musculoskeletal Pharmaco- and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, GREMPAL Research Group, IDIAP Jordi Gol Primary Care Research Institute, Autonomous University of Barcelona, CIBER of Healthy Ageing and Frailty Research (CIBERFes), Instituto de Salud Carlos III |
| BackLink | https://www.ncbi.nlm.nih.gov/pubmed/28630427$$D View this record in MEDLINE/PubMed |
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| Snippet | Despite normal to high bone mineral density, patients with type 2 diabetes (T2DM) have an increased fracture risk. T2DM medications could partially account for... Abstract Despite normal to high bone mineral density, patients with type 2 diabetes (T2DM) have an increased fracture risk. T2DM medications could partially... |
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| SubjectTerms | 692/163/2743/137/138 692/163/2743/316/801 Bone mineral density Cohort analysis Diabetes Diabetes mellitus Fractures Health risk assessment Humanities and Social Sciences Insulin multidisciplinary Population studies Science Science (multidisciplinary) |
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| Title | Insulin use and Excess Fracture Risk in Patients with Type 2 Diabetes: A Propensity-Matched cohort analysis |
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