title: Increased risk of fracture and postfracture adverse events in patients with diabetes: two nationwide population-based retrospective cohort studies.
abstract: OBJECTIVE
  The relationship between diabetes and fracture is not completely understood. This study evaluated fracture risk and postfracture mortality in patients with diabetes.
  
  
  METHODS
  We identified 32,471 adults newly diagnosed with diabetes in 2000-2003 using Taiwan's National Health Insurance Research Database. A comparison cohort of 64,942 adults without diabetes was randomly selected from the same dataset, with frequency matched by age and sex. Fracture events in 2000-2008 were ascertained from medical claims. Adjusted hazard ratios (HRs) and 95% CIs of fracture associated with diabetes were calculated. A nested cohort study of 17,002 patients with fracture receiving repair surgeries between 2004 and 2010 calculated adjusted odds ratios (ORs) and 95% CIs of adverse events after fracture in patients with and without diabetes.
  
  
  RESULTS
  During 652,530 person-years of follow-up, there were 12,772 newly diagnosed fracture cases. The incidences of fracture for people with diabetes and without were 24.2 and 17.1 per 1,000 person-years, respectively (P < 0.0001). Compared with people without diabetes, the adjusted HR of fracture was 1.66 (95% CI 1.60-1.72) for people with diabetes. The ORs of postfracture deep wound infection, septicemia, and mortality associated with diabetes were 1.34 (95% CI 1.06-1.71), 1.42 (95% CI 1.23-1.64), and 1.27 (95% CI 1.02-1.60), respectively.
  
  
  CONCLUSIONS
  Diabetes was associated with fracture. Patients with diabetes had more adverse events and subsequent mortality after fracture. Prevention of fracture and postfracture adverse events is needed in this susceptible population.
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, TaiwanHealth Policy Research Center, Taipei Medical University Hospital, Taipei, TaiwanSchool of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chien-Chang
authors.initials: CC
authors.lastname: Liao
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, TaiwanHealth Policy Research Center, Taipei Medical University Hospital, Taipei, TaiwanSchool of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: Chao-Shun
authors.initials: CS
authors.lastname: Lin
authors.affiliation: School of Chinese Medicine for Post-Baccalaureate, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Chun-Chuan
authors.initials: CC
authors.lastname: Shih
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, TaiwanDepartment of Surgery, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chun-Chieh
authors.initials: CC
authors.lastname: Yeh
authors.affiliation: Department of Medicine, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Yi-Cheng
authors.initials: YC
authors.lastname: Chang
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Yuan-Wen
authors.initials: YW
authors.lastname: Lee
authors.affiliation: Department of Anesthesiology, Taipei Medical University Hospital, Taipei, TaiwanHealth Policy Research Center, Taipei Medical University Hospital, Taipei, TaiwanSchool of Medicine, Taipei Medical University, Taipei, Taiwan tlc@tmu.edu.tw.
authors.forename: Ta-Liang
authors.initials: TL
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D048909:Diabetes Complications / Q000453:epidemiology* / Q000401:mortality; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D050723:Fractures, Bone / Q000150:complications* / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult