The association between hyperglycemia and fracture risk in middle age. A prospective, population-based study of 22,444 men and 10,902 women.
OBJECTIVE
Type 1 diabetes mellitus is associated with increased fracture risk, whereas the risk associated with type 2 diabetes is less obvious. Elevated fasting blood glucose and high 2-h glucose during an oral glucose tolerance test indicate impaired glucose tolerance or diabetes. The associations among fasting blood glucose, 2-h glucose, and the risk of fracture were investigated.


METHODS
The Malmö Preventive Project consists of 22,444 men (44+/-6.6 yr) and 10,902 women (50+/-7.4 yr), with a follow-up of 19 yr (+/-3.9) and 15 yr (+/-4.5) for incident fractures. Baseline assessment included multiple examinations and lifestyle information. A logistic regression model was used. Adjustments were made for age, body mass index (BMI), and smoking.


RESULTS
Low-energy fractures were recorded in 1246 men and 1236 women. A 2-h glucose measurement between 4.3 and 6.2 mmol/liter in men (second and third quartile), and above 6.5 mmol/liter in women (third and fourth quartile), adjusted for age, BMI, and smoking, was significantly associated with a decreased risk of multiple fractures, in men [odds ratios (ORs) 0.57-0.71] and women (ORs 0.38-0.66). In women, a 2-h glucose measurement above 7.5 mmol/liter was associated with a decreased risk of osteoporotic fractures (OR 0.57, 95% confidence interval 0.44-0.74).


CONCLUSIONS
In middle-aged men and women, elevated 2-h glucose levels were associated with decreased risks of multiple and osteoporotic fractures, independent of age, BMI, and smoking. A high 2-h glucose level is characterized by peripheral insulin resistance with a high insulin level. Our findings indirectly suggest a positive effect on bone from hyperglycemia.
Holmberg
A H
AH
Lund University, Department of Clinical Sciences, Malmö University Hospital, S-205 02 Malmö, Sweden. Anna.Holmberg@skane.se
Nilsson
P M
PM
Nilsson
J-A
JA
Akesson
K
K
D000328:Adult; D001786:Blood Glucose / Q000032:analysis; D015992:Body Mass Index; D005215:Fasting / Q000097:blood; D005260:Female; D050723:Fractures, Bone / Q000209:etiology*; D005951:Glucose Tolerance Test; D006801:Humans; D006943:Hyperglycemia / Q000150:complications*; D007333:Insulin Resistance; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies
D001786:Blood Glucose