Trial reportThe Journal of clinical endocrinology and metabolism2025
Predictors of Fracture in Middle-Aged and Older Adults With Type 2 Diabetes and Overweight or Obesity.
Trial report in The Journal of clinical endocrinology and metabolism, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.
What it found
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
1 citing paper in PubMed.
- 10-Year Fracture Risk Assessment with Novel Adjustment (FRAXplus): Type 2 Diabetic Sample-Focused Analysis.Diagnostics (Basel, Switzerland) · 2025Article
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Authors and funding
6 authors.
Funding
Abstract
contextPersons with type 2 diabetes have increased fracture risk that existing fracture risk assessment tools underestimate.
objectiveIdentify fracture predictors in persons with type 2 diabetes and overweight or obesity, considering traditional and diabetes-related risk factors.
methodsThis is a secondary analysis of a multicenter US study, the Look AHEAD: Action for Health in Diabetes randomized clinical trial, with randomization from 2001 to 2004 and fracture follow-up until 2015. Participants were men and women 45 to 75 years old with type 2 diabetes and body mass index ≥ 25 kg/m2. Potential fracture predictors ascertained at randomization included traditional and diabetes-related risk factors (diabetes duration, diabetic neuropathy, antidiabetic medication use, hemoglobin A1c, and renal function). Total hip bone mineral density (BMD) was measured in a subcohort. Primary outcome was all incident clinical fractures, ascertained by self-report and centrally adjudicated with medical records review.
resultsOver a median 12.2-year follow-up, 649 of the 4703 participants experienced at least one clinical fracture. Thiazolidinedione use (hazard ratio [HR] 1.22; 95% CI, 1.02-1.46) and insulin use (HR 1.34, 95% CI, 1.08-1.66) were significant diabetes-related predictors of all clinical fractures. When measured in a subcohort (n = 1285), total hip BMD was the strongest modifiable predictor of all clinical fractures (per 1 SD = 0.1 g/cm2 increase, HR 0.47; 95% CI, 0.39-0.58).
conclusionThiazolidinedione and insulin use predict clinical fracture in middle-aged and older persons with type 2 diabetes and overweight or obesity. Evaluating BMD is advisable if these medications are prescribed. Fracture risk prediction tools may consider including thiazolidinedione and insulin use to refine prediction in this population.
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