Diabetes and risk of fracture: The Blue Mountains Eye Study.
OBJECTIVE
To examine associations between measures of diabetes and risk of fracture in a population-based sample of older Australians.


METHODS
This was a prospective study of 3,654 subjects aged 49 years and older who were residents in the Blue Mountains, west of Sydney, Australia. At baseline, subjects were asked questions about history and treatment of diabetes, and fasting blood samples were taken. Photographs were taken of the retina and lens to grade retinopathy and cataract. Details of fractures (excluding rib and vertebral fractures) were collected by a combination of self-report and medical record searches; all fractures were radiologically confirmed.


RESULTS
After 2 years of follow-up, we found that several diabetes-related factors were significantly associated (in multivariate models) with increased risk of all fractures combined, including presence of diabetic retinopathy (adjusted RR 5.4, 95% CI 2.7-10.8), diabetes duration > or = 10 years (3.3, 1.3-8.2), cortical cataract involving > or = 25% of the lens area (2.5, 1.3-4.7), and insulin treatment (5.9, 2.6-13.5). The proximal humerus was the only individual fracture site associated with diabetes. Diabetic retinopathy (10.3, 2.2-48.0), diabetes duration (for > or = 10 years duration; 11.4, 2.4-54.2), and insulin treatment (18.8, 4.0-88.7) were all associated with proximal humerus fracture.


CONCLUSIONS
These data suggest a significantly increased risk of fracture associated with diabetic retinopathy, advanced cortical cataract, longer diabetes duration, and insulin treatment. However, there are some shortcomings in this study that may limit these findings.
Ivers
R Q
RQ
Institute for International Health, the University of Sydney, NSW 2042, Australia. rivers@iih.usyd.edu.au
Cumming
R G
RG
Mitchell
P
P
Peduto
A J
AJ
D000368:Aged; D001315:Australia / Q000453:epidemiology; D001786:Blood Glucose / Q000378:metabolism; D002386:Cataract / Q000453:epidemiology*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000503:physiopathology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology*; D005128:Eye Diseases / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D050723:Fractures, Bone / Q000453:epidemiology*; D006620:Hip Fractures / Q000453:epidemiology; D006801:Humans; D006810:Humeral Fractures / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D013997:Time Factors
D001786:Blood Glucose