title: Risk of fracture in women with type 2 diabetes: the Women's Health Initiative Observational Study.
abstract: BACKGROUND
  Some but not all studies have shown higher rates of fracture in individuals with type 2 diabetes.
  
  
  OBJECTIVE
  The objective of the study was to determine the risk of fracture in postmenopausal women with type 2 diabetes and determine whether risk varies by fracture site, ethnicity, and baseline bone density.
  
  
  METHODS
  Women with clinically diagnosed type 2 diabetes at baseline in the Women's Health Initiative Observational Cohort, a prospective study of postmenopausal women (n = 93,676), were compared with women without diagnosed diabetes and risk of fracture overall and at specific sites determined.
  
  
  METHODS
  All fractures and specific sites separately (hip/pelvis/upper leg; lower leg/ankle/knee; foot; upper arm/shoulder/elbow; lower arm/wrist/hand; spine/tailbone) were measured. Bone mineral density (BMD) in a subset also was measured.
  
  
  RESULTS
  The overall risk of fracture after 7 yr of follow-up was higher in women with diabetes at baseline after controlling for multiple risk factors including frequency of falls [adjusted relative risk (RR) 1.20, 95% confidence interval (CI) 1.11-1.30]. In a subsample of women with baseline BMD scores, women with diabetes had greater hip and spine BMD. The elevated fracture risk was found at multiple sites (hip/pelvis/upper leg; foot; spine/tailbone) among black women (RR 1.33, 95% CI 1.00-1.75) and women with increased baseline bone density (RR 1.26, 95% CI 0.96-1.66).
  
  
  CONCLUSIONS
  Women with type 2 diabetes are at increased risk for fractures. This risk is also seen among black and non-Hispanic white women after adjustment for multiple risk factors including frequent falls and increased BMD (in a subset).
authors.affiliation: M.P.H., Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157, USA. dbonds@wfubmc.edu
authors.forename: Denise E
authors.initials: DE
authors.lastname: Bonds
authors.forename: Joseph C
authors.initials: JC
authors.lastname: Larson
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: John
authors.initials: J
authors.lastname: Robbins
authors.forename: Beatriz L
authors.initials: BL
authors.lastname: Rodriguez
authors.forename: Karen C
authors.initials: KC
authors.lastname: Johnson
authors.forename: Karen L
authors.initials: KL
authors.lastname: Margolis
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D015519:Bone Density / Q000502:physiology; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology / Q000378:metabolism; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology / Q000209:etiology* / Q000378:metabolism; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology