title: Diabetes and bone loss at the hip in older black and white adults.
abstract: Type 2 diabetes may be associated with elevated fracture risk, but the impact on bone loss is unknown. Analysis of 4-year change in hip BMD data from a cohort of white and black well-functioning men and women 70-79 years of age found that white women with diabetes had more rapid bone loss at the femoral neck than those with normal glucose metabolism.
  
  
  BACKGROUND
  Type 2 diabetes may be associated with elevated fracture risk in older adults. Although type 2 diabetes is not associated with lower BMD, older diabetic adults have a higher prevalence of other risk factors for fracture, including more frequent falls, functional limitations, and diabetic complications. With this burden of risk factors, loss of BMD could place older adults with diabetes at higher risk of sustaining a fracture.
  
  
  METHODS
  To determine if bone loss is increased with type 2 diabetes, we analyzed data from the Health, Aging, and Body Composition Study of white and black well-functioning men and women 70-79 years of age. Hip BMD was measured at baseline and 4 years later in 480 (23%) participants with diabetes, 439 with impaired glucose metabolism, and 1172 with normal glucose homeostasis (NG).
  
  
  RESULTS
  Those with diabetes had higher baseline hip BMD and weight, but among white women, had more weight loss over 4 years. White women with diabetes lost more femoral neck and total hip BMD than those with NG in age-adjusted models. After multivariable adjustment, diabetes was associated with greater loss of femoral neck BMD (-0.32%/year; 95% CI: -0.61, -0.02) but not total hip BMD. In men and black women, change in hip BMD was similar for participants with diabetes and NG.
  
  
  CONCLUSIONS
  Despite having higher baseline BMD, diabetic white women, but not men or black women, had more rapid bone loss at the femoral neck than those with NG. This increased bone loss may contribute to the higher fracture risk observed in older diabetic women.
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, California 94105, USA. aschwartz@psg.ucsf.edu
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Sellmeyer
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Frances A
authors.initials: FA
authors.lastname: Tylavsky
authors.forename: Kenneth R
authors.initials: KR
authors.lastname: Feingold
authors.forename: Helaine E
authors.initials: HE
authors.lastname: Resnick
authors.forename: Ronald I
authors.initials: RI
authors.lastname: Shorr
authors.forename: Michael C
authors.initials: MC
authors.lastname: Nevitt
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Black
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cummings
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
mesh_terms: D000367:Age Factors; D000368:Aged; D044383:Black People; D001823:Body Composition; D015519:Bone Density; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000208:ethnology*; D005260:Female; D005272:Femur Neck / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D010024:Osteoporosis / Q000209:etiology*; D011859:Radiography; D044465:White People