title: Diabetes mellitus as a risk factor for hip fracture in mexican american older adults.
abstract: BACKGROUND
  Hip fracture in older adults is a significant medical, social, and economic concern to society. Little is known regarding diabetes as a risk factor for hip fracture in the Mexican American population. The objective of this study was to examine diabetes and other potential risk factors for hip fracture in a sample of community-dwelling, older, Mexican American adults.
  
  
  METHODS
  The study was a prospective cohort design involving the Hispanic Established Population for the Epidemiologic Study of the Elderly, a longitudinal study involving a weighted probability sample of Mexican American adults (>65 years) living in the southwestern United States. Included in the study were 3050 older Mexican American subjects who were originally interviewed and tested at baseline and then followed with reassessment at 2, 5, and 7 years. Incidence of hip fracture was examined for subjects over 7-year follow-up.
  
  
  RESULTS
  At baseline, 690 subjects were identified with diabetes. One hundred and thirty-four subjects experienced a first-time hip fracture during follow-up. Cox proportional hazard regression revealed an increased hazard ratio for hip fracture in subjects with diabetes compared to those without diabetes (hazard ratio = 1.57, 95% confidence interval [CI(95)] = 1.03, 2.39, p <.04) when adjusted for age, body mass index, smoking, and previous stroke. The hazard ratio for Mexican Americans taking insulin was 2.84 (CI(95) = 1.49, 5.43, p <.002) when adjusted for covariates.
  
  
  CONCLUSIONS
  We found diabetes was associated with increased risk for a hip fracture in older Mexican Americans, particularly subjects taking insulin. Diabetes has not previously been considered a risk factor for hip fracture in older adults. The high incidence of type 2 diabetes in the Mexican American population highlights the need for increased research on risk factors in this ethnic group.
authors.affiliation: Division of Rehabilitation Sciences, School of Allied Health Sciences, University of Texas Medical Branch at Galveston, TX 77555-1137, USA. Kottenba@utmb.edu
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ottenbacher
authors.forename: Glenn V
authors.initials: GV
authors.lastname: Ostir
authors.forename: M Kristen
authors.initials: MK
authors.lastname: Peek
authors.forename: James S
authors.initials: JS
authors.lastname: Goodwin
authors.forename: Kyriakos S
authors.initials: KS
authors.lastname: Markides
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015992:Body Mass Index; D003153:Community Health Services; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000208:ethnology*; D005260:Female; D005500:Follow-Up Studies; D006620:Hip Fractures / Q000453:epidemiology* / Q000208:ethnology* / Q000209:etiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D017058:Mexican Americans; D016016:Proportional Hazards Models; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects; D014481:United States / Q000453:epidemiology