title: Fractures are increased and bisphosphonate use decreased in individuals with insulin-dependent diabetes: a 10 year cohort study.
abstract: BACKGROUND
  Individuals with diabetes have been found previously to be at increased risk of non-traumatic fracture. However, it is unclear if these individuals are being identified and treated for osteoporosis.
  
  
  METHODS
  7753 Canadians over 50 years of age were followed prospectively for 10 years. 606/7753 (7.8%) of had diabetes; 98 were insulin-dependent and 508 were not. Using a cox proportional hazards model, we assessed the association between diabetes status and incident non-traumatic fracture. Using logistic regression we identified factors associated with bisphosphonate use over the 10 year period of study.
  
  
  RESULTS
  Mean (SD) age of participants was 66.7(9.4) years and 72% were female. Those with diabetes had higher BMD T-scores at baseline, with a mean (SD) femoral neck T-Score of -0.97 (1.06), compared to -1.24 (0.99) in the general cohort. The adjusted hazard ratio (HR) for incident non-traumatic fracture in individuals with insulin-dependent diabetes over the 10 year study period was 2.50 (95% confidence interval [CI] 1.60, 3.90; p < 0.001). Despite this increased fracture rate, individuals with diabetes (insulin-dependent or non-insulin-dependent) were less likely to be on bisphosphonate therapy at any point over 10 years of prospective follow up compared to other CaMos subjects (odds ratio [OR]: 0.59; 95% CI 0.46-0.75, p < 0.001).
  
  
  CONCLUSIONS
  Despite the increased risk of non-traumatic fracture associated with insulin-dependent diabetes, we that found individuals with diabetes are less likely to be treated with a bisphosphonate than those without diabetes. These findings point to a possible care gap in the treatment of non-traumatic fractures in individuals with diabetes in Canada.
authors.affiliation: Department of Medicine, University of Western Ontario, London, Ontario, Canada. Lisaann.Fraser@sjhc.london.on.ca.
authors.forename: Lisa-Ann
authors.initials: LA
authors.lastname: Fraser
authors.forename: Alexandra
authors.initials: A
authors.lastname: Papaioannou
authors.forename: Jonathan D
authors.initials: JD
authors.lastname: Adachi
authors.forename: Jinhui
authors.initials: J
authors.lastname: Ma
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
mesh_terms: D000368:Aged; D015519:Bone Density; D050071:Bone Density Conservation Agents / Q000627:therapeutic use*; D002170:Canada / Q000453:epidemiology; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D004164:Diphosphonates / Q000627:therapeutic use*; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010024:Osteoporosis / Q000150:complications / Q000188:drug therapy / Q000453:epidemiology*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012306:Risk; D011795:Surveys and Questionnaires
chemical_list: D050071:Bone Density Conservation Agents; D004164:Diphosphonates