Factors associated with fragility fractures in type 2 diabetes: An analysis of the randomised controlled Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) study.

Abstract

AIMS:

Fracture risk is elevated in some type 2 diabetes patients. Bone fragility may be associated with more clinically severe type 2 diabetes, although prospective studies are lacking. It is unknown which diabetes-related characteristics are independently associated with fracture risk. In this post-hoc analysis of fracture data from the Fenofibrate Intervention and Event Lowering in Diabetes (FIELD) trial (ISRCTN#64783481), we hypothesised that diabetic microvascular complications are associated with bone fragility.

MATERIALS AND METHODS:

The FIELD trial randomly assigned 9795 type 2 diabetes participants (aged 50-75 years) to receive oral co-micronised fenofibrate 200 mg (n = 4895) or placebo (n = 4900) daily for a median of 5 years. We used Cox proportional hazards models to identify baseline sex-specific diabetes-related parameters independently associated with incident fractures.

RESULTS:

Over 49,470 person-years, 137/6138 men experienced 141 fractures and 143/3657 women experienced 145 fractures; incidence rates for the first fracture of 4∙4 (95% CI 3∙8-5∙2) and 7∙7 per 1000 person-years (95% CI 6∙5-9∙1), respectively. Fenofibrate had no effect on fracture outcomes. In men, baseline macrovascular disease (HR 1∙52, 95% CI 1∙05-2∙21, p = 0∙03), insulin use (HR 1∙62, HR 1∙03-2∙55, p = 0∙03), and HDL-cholesterol (HR 2∙20, 95% CI 1∙11-4∙36, p = 0∙02) were independently associated with fracture. In women, independent risk factors included baseline peripheral neuropathy (HR 2∙04, 95% CI 1∙16-3∙59, p = 0∙01) and insulin use (HR 1∙55, 95% CI 1∙02-2∙33, p = 0∙04).

CONCLUSIONS:

Insulin use and sex-specific complications (in men, macrovascular disease; in women, neuropathy) are independently associated with fragility fractures in adults with type 2 diabetes.

• Authors: Angela Sheu, Rachel L O'Connell, Alicia J Jenkins, Thach Tran, Paul L Drury, David R Sullivan, LiPing Li, Peter Colman, Richard O'Brien, Y Antero Kesäniemi, Jacqueline R Center, Christopher P White, Anthony C Keech
• Journal: Diabetes/metabolism research and reviews (Diabetes Metab Res Rev) Vol. 39 Issue 5 Pg. e3631 (Jul 2023) ISSN: 1520-7560 [Electronic] England
• PMID: 36893361 (Publication Type: Journal Article, Randomized Controlled Trial)
• Copyright: © 2023 The Authors. Diabetes/Metabolism Research and Reviews published by John Wiley & Sons Ltd.

Chemical References

• Fenofibrate
• Insulins

Topics

• Adult
• Female
• Humans
• Male
• Diabetes Complications (drug therapy)
• Diabetes Mellitus, Type 2 (complications, drug therapy)
• Fenofibrate (therapeutic use)
• Fractures, Bone (epidemiology, etiology, prevention & control)
• Insulins (therapeutic use)
• Prospective Studies
• Risk Factors