Study Shines Light on Pattern of Incident Fractures in Type 1 Diabetes Patients

Pavankumar Kamat

October 14, 2021

Newly treated individuals with type 1 diabetes (T1D) not only have a higher overall incidence of fractures but are also more likely to experience fractures at distal sites. These findings were published in  Osteoporosis International .

Although there is evidence of higher incidences of fractures in patients with T1D compared with the general population, very little is known about the site-specific pattern of incident fractures in this population.

A population-based retrospective cohort study included patients of all ages with newly treated T1D (n=6381) and their matched control participants without T1D (n=6381) from the UK Clinical Practice Research Datalink GOLD database (1987-2017).

Patients with T1D had a significantly higher incidence of all fractures compared with control participants (13.8 vs 10.0 per 1000 person-years; incidence rate ratio [IRR], 1.39; 95% CI, 1.24-1.55). Patients with T1D were more likely than control participants to experience fractures at certain sites, including carpal (IRR, 1.41; 95% CI, 1.14-1.75), clavicle (IRR, 2.10; 95% CI, 1.18-3.74), foot (IRR, 1.70; 95% CI, 1.23-2.36), humerus (IRR, 1.46; 95% CI, 1.04-2.05) and tibia/fibula (IRR, 1.67; 95% CI, 1.08-2.59). There were no significant differences in fracture rates at other sites between individuals with and without T1D.

Women with T1D were more likely to experience fractures at the ankle (IRR, 2.25; 95% CI, 1.10-4.56) and foot (IRR, 2.11; 95% CI, 1.27-3.50) compared with women without T1D, whereas men with T1D had a higher likelihood of fractures at carpal (IRR, 1.45; 95% CI, 1.14-1.86), clavicle (IRR, 2.13; 95% CI, 1.13-4.02) and humerus (IRR, 1.77; 95% CI, 1.10-2.83) compared with men without T1D.

Patients with T1D aged <20 years higher were more likely to experience fractures at the carpal (IRR, 1.32; 95% CI, 1.01-1.73), foot (IRR, 1.71; 95% CI, 1.05-2.78) and humerus (IRR, 1.86; 95% CI, 1.14-3.04) as compared with individuals without T1D aged <20 years. Patients with T1D aged ≥20 years were more likely to experience fractures at the carpal (IRR, 1.52; 95% CI, 1.06-2.18), clavicle (IRR, 3.09; 95% CI, 1.23-7.79), foot (IRR, 1.71; 95% CI, 1.10-2.65) and radius/ulna (IRR, 1.63; 95% CI, 1.07-2.48) than their counterparts in the same age group without T1D.

After adjusting for body mass index, smoking and alcohol, the IRRs were slightly higher than the crude IRRs for all sites except for the foot, which remained slightly lower.

The authors stated: "This is a door opening on the topic of diabetes and fractures and a call for more rigorous and robust research to better understand any potential benefits and harms related to people with T1D and fracture patterns."

This article originally appeared on Univadis, part of the Medscape Professional Network.

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