title: Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging, and body composition study.
abstract: BACKGROUND
  Diabetes mellitus (DM) and related complications may increase clinical fracture risk in older adults.
  
  
  METHODS
  Our objectives were to determine if type 2 diabetes mellitus or impaired fasting glucose was associated with higher fracture rates in older adults and to evaluate how diabetic individuals with fractures differed from those without fractures. The Health, Aging, and Body Composition Study participants were well-functioning, community-dwelling men and women aged 70 to 79 years (N = 2979; 42% black), of whom 19% had DM and 6% had impaired fasting glucose at baseline. Incident nontraumatic clinical fractures were verified by radiology reports for a mean +/- SD of 4.5 +/- 1.1 years. Cox proportional hazards regression models determined how DM and impaired fasting glucose affected subsequent risk of fracture.
  
  
  RESULTS
  Diabetes mellitus was associated with elevated fracture risk (relative risk, 1.64; 95% confidence interval, 1.07-2.51) after adjustment for a hip bone mineral density (BMD) and fracture risk factors. Impaired fasting glucose was not significantly associated with fractures (relative risk, 1.34; 95% confidence interval, 0.67-2.67). Diabetic participants with fractures had lower hip BMD (0.818 g/cm(2) vs 0.967 g/cm(2); P<.001) and lean mass (44.3 kg vs 51.7 kg) and were more likely to have reduced peripheral sensation (35% vs 14%), transient ischemic attack/stroke (20% vs 8%), a lower physical performance battery score (5.0 vs 7.0), and falls (37% vs 21%) compared with diabetic participants without fractures (P<.05).
  
  
  CONCLUSIONS
  These results indicate that older white and black adults with DM are at higher fracture risk compared with nondiabetic adults with a similar BMD since a higher risk of nontraumatic fractures was found after adjustment for hip BMD. Fracture prevention needs to target specific risk factors found in older adults with DM.
authors.affiliation: Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, PA 15213, USA.
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Jane A
authors.initials: JA
authors.lastname: Cauley
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
authors.forename: Michael C
authors.initials: MC
authors.lastname: Nevitt
authors.forename: Helaine E
authors.initials: HE
authors.lastname: Resnick
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Frances A
authors.initials: FA
authors.lastname: Tylavsky
authors.forename: Nathalie
authors.initials: N
authors.lastname: de Rekeneire
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Anne B
authors.initials: AB
authors.lastname: Newman
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D000368:Aged; D001786:Blood Glucose / Q000378:metabolism*; D015519:Bone Density; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005215:Fasting; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology*; D006801:Humans; D015994:Incidence; D008297:Male; D015999:Multivariate Analysis; D016016:Proportional Hazards Models; D018570:Risk Assessment; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose