Risk Factors for Fracture in Diabetes: The Canadian Multicentre Osteoporosis Study

Objective. Individuals with diabetes have been found to be at increased risk of nontraumatic fracture. However, within the diabetic population, how to distinguish who is at the highest risk and warranting therapy has remained elusive. Design. Cross-sectional analysis of a national population-based cohort study. Patients. Men and women over the age of 50 with diabetes from across Canada. Measurements. Logistic regression analysis to identify diabetes specific factors associated with a history of one or more non-traumatic fractures. Results. Six hundred and six individuals with diabetes with a mean age of 69 years were examined. Thirty percent had a history of non-traumatic fracture. Macrovascular diseases in the form of stroke or TIA, as well as hypertension, were found to be independently associated with fragility fracture. Other, more traditional, clinical risk factors were also associated with fracture, including increased age, female gender, rheumatoid arthritis, family history of osteoporosis, and decreased bone mineral density. Conclusions. In this cohort of Canadians with diabetes, those with rheumatoid arthritis, a family history of osteoporosis, female gender, increased age, decreased BMD, cerebrovascular disease, or hypertension were more likely to have had a non-traumatic fracture. These risk factors may be important to clinicians when identifying which of their diabetic patients are at highest risk of fracture and in need of preventative therapies. 1. Introduction Multiple studies have identified individuals with diabetes as being at increased risk of nontraumatic (fragility) fracture [1, 2]. This is a growing concern as the rates of both diabetes and osteoporosis continue to increase in society [3, 4]. In Canada, over 9 million people are living with diabetes or prediabetes, and the number is expected to rise to pandemic levels by 2030 when the global incidence of the disease is predicted to hit 438 million [4, 5]. Osteoporosis, defined as a t-score of <？2.5, is also common within the Canadian population with 21% of Canadian women and 5% of Canadian men over the age of 50 being affected [6]. Many physicians use bone mineral density (BMD) in addition to fracture to diagnose osteoporosis and to identify individuals in need of therapy for prevention of osteoporotic fractures. In the diabetic population this is a problem. Although type 1 diabetes is often associated with decreased BMD values, those with type 2 diabetes usually have normal or higher than expected BMD values [2]. Similarly, although BMD value is an important risk factor for