Frailty and Risk of Fractures in Patients With Type 2 Diabetes
We aimed to explore whether frailty was associated with fracture risk and whether frailty could modify the propensity of type 2 diabetes toward increased risk of fractures. Data were from a prospective cohort study. Our primary outcome was time to the first incident clinical fragility fracture; seco...
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| Veröffentlicht in: | Diabetes care 2019-04, Vol.42 (4), p.507-513 |
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| creator | Li, Guowei Prior, Jerilynn C Leslie, William D Thabane, Lehana Papaioannou, Alexandra Josse, Robert G Kaiser, Stephanie M Kovacs, Christopher S Anastassiades, Tassos Towheed, Tanveer Davison, K Shawn Levine, Mitchell Goltzman, David Adachi, Jonathan D |
| description | We aimed to explore whether frailty was associated with fracture risk and whether frailty could modify the propensity of type 2 diabetes toward increased risk of fractures.
Data were from a prospective cohort study. Our primary outcome was time to the first incident clinical fragility fracture; secondary outcomes included time to hip fracture and to clinical spine fracture. Frailty status was measured by a Frailty Index (FI) of deficit accumulation. The Cox model incorporating an interaction term (frailty × diabetes) was used for analyses.
The analysis included 3,149 (70% women) participants; 138 (60% women) had diabetes. Higher bone mineral density and FI were observed in participants with diabetes compared with control subjects. A significant relationship between the FI and the risk of incident fragility fractures was found, with a hazard ratio (HR) of 1.02 (95% CI 1.01-1.03) and 1.19 (95% CI 1.10-1.33) for per-0.01 and per-0.10 FI increase, respectively. The interaction was also statistically significant (
= 0.018). The HR for per-0.1 increase in the FI was 1.33 for participants with diabetes and 1.19 for those without diabetes if combining the estimate for the FI itself with the estimate from the interaction term. No evidence of interaction between frailty and diabetes was found for risk of hip and clinical spine fractures.
Participants with type 2 diabetes were significantly frailer than individuals without diabetes. Frailty increases the risk of fragility fracture and enhances the effect of diabetes on fragility fractures. Particular attention should be paid to diabetes as a risk factor for fragility fractures in those who are frail. |
| doi_str_mv | 10.2337/dc18-1965 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2179466631</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2179466631</sourcerecordid><originalsourceid>FETCH-LOGICAL-c348t-2e45676fc66ce936e4c212c2321b9594c29253edaf0507657fabf155b745eb6a3</originalsourceid><addsrcrecordid>eNpdkE1Lw0AQhhdRbK0e_AOy4EUP0f1O9iJItSoUFKl4XDabCaamSd3dHPrv3WL14Gl4h4eXmQehU0quGOf5deVokVGt5B4aU81lJqUo9tGYUKEzqTUboaMQloQQIYriEI04UZoxQcboZuZt08YNtl2FX5vwifsap52Lg4eAmw6_2NhAFwN-b-IHXmzWgBm-a2wJEcIxOqhtG-BkNyfobXa_mD5m8-eHp-ntPHNcFDFjIKTKVe2UcqC5AuEYZY5xRkstdUqaSQ6VrYkkuZJ5bcuaSlnmQkKpLJ-gi5_ete-_BgjRrJrgoG1tB_0QDKO5FkopThN6_g9d9oPv0nWGpZ-Tr4KqRF3-UM73IXiozdo3K-s3hhKzlWq2Us1WamLPdo1DuYLqj_y1yL8BZj5ucQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2224337816</pqid></control><display><type>article</type><title>Frailty and Risk of Fractures in Patients With Type 2 Diabetes</title><source>MEDLINE</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Li, Guowei ; Prior, Jerilynn C ; Leslie, William D ; Thabane, Lehana ; Papaioannou, Alexandra ; Josse, Robert G ; Kaiser, Stephanie M ; Kovacs, Christopher S ; Anastassiades, Tassos ; Towheed, Tanveer ; Davison, K Shawn ; Levine, Mitchell ; Goltzman, David ; Adachi, Jonathan D</creator><creatorcontrib>Li, Guowei ; Prior, Jerilynn C ; Leslie, William D ; Thabane, Lehana ; Papaioannou, Alexandra ; Josse, Robert G ; Kaiser, Stephanie M ; Kovacs, Christopher S ; Anastassiades, Tassos ; Towheed, Tanveer ; Davison, K Shawn ; Levine, Mitchell ; Goltzman, David ; Adachi, Jonathan D ; CaMos Research Group</creatorcontrib><description>We aimed to explore whether frailty was associated with fracture risk and whether frailty could modify the propensity of type 2 diabetes toward increased risk of fractures.
Data were from a prospective cohort study. Our primary outcome was time to the first incident clinical fragility fracture; secondary outcomes included time to hip fracture and to clinical spine fracture. Frailty status was measured by a Frailty Index (FI) of deficit accumulation. The Cox model incorporating an interaction term (frailty × diabetes) was used for analyses.
The analysis included 3,149 (70% women) participants; 138 (60% women) had diabetes. Higher bone mineral density and FI were observed in participants with diabetes compared with control subjects. A significant relationship between the FI and the risk of incident fragility fractures was found, with a hazard ratio (HR) of 1.02 (95% CI 1.01-1.03) and 1.19 (95% CI 1.10-1.33) for per-0.01 and per-0.10 FI increase, respectively. The interaction was also statistically significant (
= 0.018). The HR for per-0.1 increase in the FI was 1.33 for participants with diabetes and 1.19 for those without diabetes if combining the estimate for the FI itself with the estimate from the interaction term. No evidence of interaction between frailty and diabetes was found for risk of hip and clinical spine fractures.
Participants with type 2 diabetes were significantly frailer than individuals without diabetes. Frailty increases the risk of fragility fracture and enhances the effect of diabetes on fragility fractures. Particular attention should be paid to diabetes as a risk factor for fragility fractures in those who are frail.</description><identifier>ISSN: 0149-5992</identifier><identifier>EISSN: 1935-5548</identifier><identifier>DOI: 10.2337/dc18-1965</identifier><identifier>PMID: 30692240</identifier><language>eng</language><publisher>United States: American Diabetes Association</publisher><subject>Aged ; Bone mineral density ; Canada - epidemiology ; Diabetes ; Diabetes Complications - epidemiology ; Diabetes mellitus ; Diabetes mellitus (non-insulin dependent) ; Diabetes Mellitus, Type 2 - complications ; Diabetes Mellitus, Type 2 - epidemiology ; Female ; Fractures ; Fractures, Bone - epidemiology ; Fractures, Bone - etiology ; Fragility ; Frail Elderly - statistics & numerical data ; Frailty ; Frailty - complications ; Frailty - epidemiology ; Health risks ; Hip ; Hip Fractures - epidemiology ; Hip Fractures - etiology ; Humans ; Male ; Middle Aged ; Osteoporosis - complications ; Osteoporosis - epidemiology ; Prevalence ; Proportional Hazards Models ; Prospective Studies ; Research design ; Risk analysis ; Risk Factors ; Spine ; Statistical analysis</subject><ispartof>Diabetes care, 2019-04, Vol.42 (4), p.507-513</ispartof><rights>2019 by the American Diabetes Association.</rights><rights>Copyright American Diabetes Association Apr 1, 2019</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c348t-2e45676fc66ce936e4c212c2321b9594c29253edaf0507657fabf155b745eb6a3</citedby><cites>FETCH-LOGICAL-c348t-2e45676fc66ce936e4c212c2321b9594c29253edaf0507657fabf155b745eb6a3</cites><orcidid>0000-0002-3472-8513</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,782,786,27933,27934</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30692240$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Li, Guowei</creatorcontrib><creatorcontrib>Prior, Jerilynn C</creatorcontrib><creatorcontrib>Leslie, William D</creatorcontrib><creatorcontrib>Thabane, Lehana</creatorcontrib><creatorcontrib>Papaioannou, Alexandra</creatorcontrib><creatorcontrib>Josse, Robert G</creatorcontrib><creatorcontrib>Kaiser, Stephanie M</creatorcontrib><creatorcontrib>Kovacs, Christopher S</creatorcontrib><creatorcontrib>Anastassiades, Tassos</creatorcontrib><creatorcontrib>Towheed, Tanveer</creatorcontrib><creatorcontrib>Davison, K Shawn</creatorcontrib><creatorcontrib>Levine, Mitchell</creatorcontrib><creatorcontrib>Goltzman, David</creatorcontrib><creatorcontrib>Adachi, Jonathan D</creatorcontrib><creatorcontrib>CaMos Research Group</creatorcontrib><title>Frailty and Risk of Fractures in Patients With Type 2 Diabetes</title><title>Diabetes care</title><addtitle>Diabetes Care</addtitle><description>We aimed to explore whether frailty was associated with fracture risk and whether frailty could modify the propensity of type 2 diabetes toward increased risk of fractures.
Data were from a prospective cohort study. Our primary outcome was time to the first incident clinical fragility fracture; secondary outcomes included time to hip fracture and to clinical spine fracture. Frailty status was measured by a Frailty Index (FI) of deficit accumulation. The Cox model incorporating an interaction term (frailty × diabetes) was used for analyses.
The analysis included 3,149 (70% women) participants; 138 (60% women) had diabetes. Higher bone mineral density and FI were observed in participants with diabetes compared with control subjects. A significant relationship between the FI and the risk of incident fragility fractures was found, with a hazard ratio (HR) of 1.02 (95% CI 1.01-1.03) and 1.19 (95% CI 1.10-1.33) for per-0.01 and per-0.10 FI increase, respectively. The interaction was also statistically significant (
= 0.018). The HR for per-0.1 increase in the FI was 1.33 for participants with diabetes and 1.19 for those without diabetes if combining the estimate for the FI itself with the estimate from the interaction term. No evidence of interaction between frailty and diabetes was found for risk of hip and clinical spine fractures.
Participants with type 2 diabetes were significantly frailer than individuals without diabetes. Frailty increases the risk of fragility fracture and enhances the effect of diabetes on fragility fractures. Particular attention should be paid to diabetes as a risk factor for fragility fractures in those who are frail.</description><subject>Aged</subject><subject>Bone mineral density</subject><subject>Canada - epidemiology</subject><subject>Diabetes</subject><subject>Diabetes Complications - epidemiology</subject><subject>Diabetes mellitus</subject><subject>Diabetes mellitus (non-insulin dependent)</subject><subject>Diabetes Mellitus, Type 2 - complications</subject><subject>Diabetes Mellitus, Type 2 - epidemiology</subject><subject>Female</subject><subject>Fractures</subject><subject>Fractures, Bone - epidemiology</subject><subject>Fractures, Bone - etiology</subject><subject>Fragility</subject><subject>Frail Elderly - statistics & numerical data</subject><subject>Frailty</subject><subject>Frailty - complications</subject><subject>Frailty - epidemiology</subject><subject>Health risks</subject><subject>Hip</subject><subject>Hip Fractures - epidemiology</subject><subject>Hip Fractures - etiology</subject><subject>Humans</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Osteoporosis - complications</subject><subject>Osteoporosis - epidemiology</subject><subject>Prevalence</subject><subject>Proportional Hazards Models</subject><subject>Prospective Studies</subject><subject>Research design</subject><subject>Risk analysis</subject><subject>Risk Factors</subject><subject>Spine</subject><subject>Statistical analysis</subject><issn>0149-5992</issn><issn>1935-5548</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpdkE1Lw0AQhhdRbK0e_AOy4EUP0f1O9iJItSoUFKl4XDabCaamSd3dHPrv3WL14Gl4h4eXmQehU0quGOf5deVokVGt5B4aU81lJqUo9tGYUKEzqTUboaMQloQQIYriEI04UZoxQcboZuZt08YNtl2FX5vwifsap52Lg4eAmw6_2NhAFwN-b-IHXmzWgBm-a2wJEcIxOqhtG-BkNyfobXa_mD5m8-eHp-ntPHNcFDFjIKTKVe2UcqC5AuEYZY5xRkstdUqaSQ6VrYkkuZJ5bcuaSlnmQkKpLJ-gi5_ete-_BgjRrJrgoG1tB_0QDKO5FkopThN6_g9d9oPv0nWGpZ-Tr4KqRF3-UM73IXiozdo3K-s3hhKzlWq2Us1WamLPdo1DuYLqj_y1yL8BZj5ucQ</recordid><startdate>201904</startdate><enddate>201904</enddate><creator>Li, Guowei</creator><creator>Prior, Jerilynn C</creator><creator>Leslie, William D</creator><creator>Thabane, Lehana</creator><creator>Papaioannou, Alexandra</creator><creator>Josse, Robert G</creator><creator>Kaiser, Stephanie M</creator><creator>Kovacs, Christopher S</creator><creator>Anastassiades, Tassos</creator><creator>Towheed, Tanveer</creator><creator>Davison, K Shawn</creator><creator>Levine, Mitchell</creator><creator>Goltzman, David</creator><creator>Adachi, Jonathan D</creator><general>American Diabetes Association</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>K9.</scope><scope>NAPCQ</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-3472-8513</orcidid></search><sort><creationdate>201904</creationdate><title>Frailty and Risk of Fractures in Patients With Type 2 Diabetes</title><author>Li, Guowei ; Prior, Jerilynn C ; Leslie, William D ; Thabane, Lehana ; Papaioannou, Alexandra ; Josse, Robert G ; Kaiser, Stephanie M ; Kovacs, Christopher S ; Anastassiades, Tassos ; Towheed, Tanveer ; Davison, K Shawn ; Levine, Mitchell ; Goltzman, David ; Adachi, Jonathan D</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c348t-2e45676fc66ce936e4c212c2321b9594c29253edaf0507657fabf155b745eb6a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Aged</topic><topic>Bone mineral density</topic><topic>Canada - epidemiology</topic><topic>Diabetes</topic><topic>Diabetes Complications - epidemiology</topic><topic>Diabetes mellitus</topic><topic>Diabetes mellitus (non-insulin dependent)</topic><topic>Diabetes Mellitus, Type 2 - complications</topic><topic>Diabetes Mellitus, Type 2 - epidemiology</topic><topic>Female</topic><topic>Fractures</topic><topic>Fractures, Bone - epidemiology</topic><topic>Fractures, Bone - etiology</topic><topic>Fragility</topic><topic>Frail Elderly - statistics & numerical data</topic><topic>Frailty</topic><topic>Frailty - complications</topic><topic>Frailty - epidemiology</topic><topic>Health risks</topic><topic>Hip</topic><topic>Hip Fractures - epidemiology</topic><topic>Hip Fractures - etiology</topic><topic>Humans</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Osteoporosis - complications</topic><topic>Osteoporosis - epidemiology</topic><topic>Prevalence</topic><topic>Proportional Hazards Models</topic><topic>Prospective Studies</topic><topic>Research design</topic><topic>Risk analysis</topic><topic>Risk Factors</topic><topic>Spine</topic><topic>Statistical analysis</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Li, Guowei</creatorcontrib><creatorcontrib>Prior, Jerilynn C</creatorcontrib><creatorcontrib>Leslie, William D</creatorcontrib><creatorcontrib>Thabane, Lehana</creatorcontrib><creatorcontrib>Papaioannou, Alexandra</creatorcontrib><creatorcontrib>Josse, Robert G</creatorcontrib><creatorcontrib>Kaiser, Stephanie M</creatorcontrib><creatorcontrib>Kovacs, Christopher S</creatorcontrib><creatorcontrib>Anastassiades, Tassos</creatorcontrib><creatorcontrib>Towheed, Tanveer</creatorcontrib><creatorcontrib>Davison, K Shawn</creatorcontrib><creatorcontrib>Levine, Mitchell</creatorcontrib><creatorcontrib>Goltzman, David</creatorcontrib><creatorcontrib>Adachi, Jonathan D</creatorcontrib><creatorcontrib>CaMos Research Group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Premium</collection><collection>MEDLINE - Academic</collection><jtitle>Diabetes care</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Li, Guowei</au><au>Prior, Jerilynn C</au><au>Leslie, William D</au><au>Thabane, Lehana</au><au>Papaioannou, Alexandra</au><au>Josse, Robert G</au><au>Kaiser, Stephanie M</au><au>Kovacs, Christopher S</au><au>Anastassiades, Tassos</au><au>Towheed, Tanveer</au><au>Davison, K Shawn</au><au>Levine, Mitchell</au><au>Goltzman, David</au><au>Adachi, Jonathan D</au><aucorp>CaMos Research Group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Frailty and Risk of Fractures in Patients With Type 2 Diabetes</atitle><jtitle>Diabetes care</jtitle><addtitle>Diabetes Care</addtitle><date>2019-04</date><risdate>2019</risdate><volume>42</volume><issue>4</issue><spage>507</spage><epage>513</epage><pages>507-513</pages><issn>0149-5992</issn><eissn>1935-5548</eissn><abstract>We aimed to explore whether frailty was associated with fracture risk and whether frailty could modify the propensity of type 2 diabetes toward increased risk of fractures.
Data were from a prospective cohort study. Our primary outcome was time to the first incident clinical fragility fracture; secondary outcomes included time to hip fracture and to clinical spine fracture. Frailty status was measured by a Frailty Index (FI) of deficit accumulation. The Cox model incorporating an interaction term (frailty × diabetes) was used for analyses.
The analysis included 3,149 (70% women) participants; 138 (60% women) had diabetes. Higher bone mineral density and FI were observed in participants with diabetes compared with control subjects. A significant relationship between the FI and the risk of incident fragility fractures was found, with a hazard ratio (HR) of 1.02 (95% CI 1.01-1.03) and 1.19 (95% CI 1.10-1.33) for per-0.01 and per-0.10 FI increase, respectively. The interaction was also statistically significant (
= 0.018). The HR for per-0.1 increase in the FI was 1.33 for participants with diabetes and 1.19 for those without diabetes if combining the estimate for the FI itself with the estimate from the interaction term. No evidence of interaction between frailty and diabetes was found for risk of hip and clinical spine fractures.
Participants with type 2 diabetes were significantly frailer than individuals without diabetes. Frailty increases the risk of fragility fracture and enhances the effect of diabetes on fragility fractures. Particular attention should be paid to diabetes as a risk factor for fragility fractures in those who are frail.</abstract><cop>United States</cop><pub>American Diabetes Association</pub><pmid>30692240</pmid><doi>10.2337/dc18-1965</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-3472-8513</orcidid><oa>free_for_read</oa></addata></record> |
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| subjects | Aged Bone mineral density Canada - epidemiology Diabetes Diabetes Complications - epidemiology Diabetes mellitus Diabetes mellitus (non-insulin dependent) Diabetes Mellitus, Type 2 - complications Diabetes Mellitus, Type 2 - epidemiology Female Fractures Fractures, Bone - epidemiology Fractures, Bone - etiology Fragility Frail Elderly - statistics & numerical data Frailty Frailty - complications Frailty - epidemiology Health risks Hip Hip Fractures - epidemiology Hip Fractures - etiology Humans Male Middle Aged Osteoporosis - complications Osteoporosis - epidemiology Prevalence Proportional Hazards Models Prospective Studies Research design Risk analysis Risk Factors Spine Statistical analysis |
| title | Frailty and Risk of Fractures in Patients With Type 2 Diabetes |
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