title: Fracture risk in diabetic elderly men: the MrOS study.
abstract: OBJECTIVE
  Diabetes mellitus is associated with increased fracture risk in women but few studies are available in men. To evaluate the relationship between diabetes and prospective non-vertebral fractures in elderly men, we used data from the Osteoporotic Fractures in Men (MrOS) study.
  
  
  METHODS
  The MrOS enrolled 5,994 men (aged ≥65 years). Diabetes (ascertained by self-report, the use of medication for diabetes or an elevated fasting glucose level) was reported in 881 individuals, 80 of whom were using insulin. Hip and spine bone mineral density (BMD) was measured using dual x-ray absorptiometry (DXA). After recruitment, the men were followed for incident non-vertebral fractures using a triannual (3 yearly) questionnaire for an average of 9.1 (SD 2.7) years. The Cox proportional hazards model was used to assess the incident risk of fractures.
  
  
  RESULTS
  In models adjusted for age, race, clinic site and total hip BMD, the risk of non-vertebral fracture was higher in men with diabetes compared with normoglycaemic men (HR 1.30, 95% CI 1.09, 1.54) and was elevated in men using insulin (HR 2.46, 95% CI 1.69, 3.59). Men with impaired fasting glucose did not have a higher risk of fracture compared with normoglycaemic men (HR 1.04, 95% CI 0.89, 1.21). After multivariable adjustment, the risk of non-vertebral fracture remained higher only among men with diabetes who were using insulin (HR 1.74, 95% CI 1.13, 2.69).
  
  
  CONCLUSIONS
  Men with diabetes who are using insulin have an increased risk of non-vertebral fracture for a given age and BMD.
authors.affiliation: Division of Endocrinology and Diabetes, Università Campus Bio-Medico di Roma, Via Alvaro del Portillo, Rome, Italy, n.napoli@unicampus.it.
authors.forename: Nicola
authors.initials: N
authors.lastname: Napoli
authors.forename: Elsa S
authors.initials: ES
authors.lastname: Strotmeyer
authors.forename: Kristine E
authors.initials: KE
authors.lastname: Ensrud
authors.forename: Deborah E
authors.initials: DE
authors.lastname: Sellmeyer
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Bauer
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Hoffman
authors.forename: Thuy-Tien L
authors.initials: TT
authors.lastname: Dam
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Barrett-Connor
authors.forename: Lisa
authors.initials: L
authors.lastname: Palermo
authors.forename: Eric S
authors.initials: ES
authors.lastname: Orwoll
authors.forename: Steven R
authors.initials: SR
authors.lastname: Cummings
authors.forename: Dennis M
authors.initials: DM
authors.lastname: Black
authors.forename: Ann V
authors.initials: AV
authors.lastname: Schwartz
mesh_terms: D015502:Absorptiometry, Photon; D000368:Aged; D000369:Aged, 80 and over; D015519:Bone Density; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology*; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology / Q000378:metabolism; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D007328:Insulin