ArticleJournal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research2018
Differential Mortality and the Excess Rates of Hip Fracture Associated With Type 2 Diabetes: Accounting for Competing Risks in Fracture Prediction Matters.
Article in Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research, 2018. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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Who cites it
15 citing papers in PubMed, 33 citations in OpenAlex.
- Adjusting fracture probability according to duration of diabetes: the Manitoba BMD Registry.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2026Article
- Trends in hip fracture rates in spain from 2001 to 2018.Archives of osteoporosis · 2024Observational
- Proteinuria screening and risk of bone fracture: a retrospective cohort study using a nationwide population-based database.Clinical kidney journal · 2024Article
- Advantages and Disadvantages of Random Forest Models for Prediction of Hip Fracture Risk Versus Mortality Risk in the Oldest Old.JBMR plus · 2023Article
- Predictive capacity of FRAX in a spanish region with a hip fracture rate close to the national mean.BMC musculoskeletal disorders · 2023Article
- One-Year Postfracture Mortality Rate in Older Adults With Hip Fractures Relative to Other Lower Extremity Fractures: Retrospective Cohort Study.JMIR aging · 2022Article
- Sedentary lifestyle and body composition in type 2 diabetes.Diabetology & metabolic syndrome · 2022Article
- Low serum levels of bone turnover markers are associated with perirenal fat thickness in patients with type 2 diabetes mellitus.Endocrine connections · 2021Article
- Comparison of methods to improve fracture risk assessment in chinese diabetic postmenopausal women: a case-control study.Endocrine · 2021Article
- The Clinical Value of the RA-Adjusted Fracture Risk Assessment Tool in the Fracture Risk Prediction of Patients with Type 2 Diabetes Mellitus in China.International journal of general medicine · 2021Article
- Why Do Falls and Lower Limb Fractures Occur More Frequently in the Diabetic Patient and How Can They Be Prevented?Diabetes therapy : research, treatment and education of diabetes and related disorders · 2020Review
- New Developments in Fracture Risk Assessment for Current Osteoporosis Reports.Current osteoporosis reports · 2020Review
- The association between type 2 diabetes mellitus, hip fracture, and post-hip fracture mortality: a multi-state cohort analysis.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2019Article
- Lentiviral‑mediated Shh reverses the adverse effects of high glucose on osteoblast function and promotes bone formation via Sonic hedgehog signaling.Molecular medicine reports · 2019Article
- Falls and Fractures in Diabetes-More than Bone Fragility.Current osteoporosis reports · 2019Review
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Authors and funding
7 authors at 6 institutions in 2 countries.
Funding
Abstract
Type 2 diabetes (T2DM) is associated with a reduced life expectancy. The latest published evidence suggests an increased risk of fractures among T2DM patients. We conducted a population-based cohort study to determine the impact of mortality as a competing risk in the study of the association between T2DM and hip fracture rates. Participants were all diagnosed T2DM patients registered in the Sistema de Información para el Desarrollo de la Investigación en Atención Primaria (SIDIAP) database aged 65 years and older; up to two non-T2DM were matched by age, sex, and primary care facility. We used Cox regression models to estimate cause-specific hazard ratio (HR) of death or hip fracture according to T2DM status. Fine and Gray models were then fitted to estimate the subhazard ratio (SHR) of hip fracture while accounting for competing risk with death and to estimate the probability of hip fracture within 5 years. A total of 55,891 T2DM and 103,093 matched non-T2DM patients were observed for a median of 8 years. Mortality was 48.8 per 1000 person years (py) in T2DM, and 33.8 per 1000 py in non-T2DM; hip fracture rates were 6.0 per 1000 py and 4.9 per 1000 py, respectively. Cox models confirmed a significant association for death and hip fracture: HR 1.51 (95% CI, 1.48 to 1.55), and HR 1.32 (95% CI, 1.24 to 1.40), respectively. Accounting for death as a competing event (Fine-Gray models), the association between T2DM and hip fracture risk remained statistically significant (SHR 1.15; 95% CI, 1.09 to 1.21) and the probability of a hip fracture within 5 years was 2.3% for TD2M and 1.9% for non-TD2M patients compared to 2.6% and 2.1% respectively using Kaplan-Meier (KM) estimates. T2DM patients have a 50% increased mortality and, after adjusting for differential survival at 5 years, a 21% increased incidence of hip fracture when compared to matched non-T2DM. Failing to account for differential mortality leads to an overestimation of fracture risk. © 2018 American Society for Bone and Mineral Research.
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