title: Predictors of mortality subsequent to a fracture in diabetes mellitus patients.
abstract: BACKGROUND
  Type-1 and type-2 diabetes mellitus (DM) are associated with an increased fracture risk and possibly an increased risk of death following a fracture.
  
  
  OBJECTIVE
  To investigate the association between diabetes-related drugs and mortality following a fracture.
  
  
  METHODS
  A nested case-control study was conducted. Cases were patients with DM who died following a fracture; controls were DM patients not dying after a fracture. We identified DM patients using the Danish National Hospital Discharge Register (1977-2011) and included information on date of DM diagnosis, date of fracture, and comorbidities. From the Danish Cause of Death Register, the date of death was collected (2008-2011). From the Central Region of Jutland, Denmark, medication use was collected (2008-2011). Analysis was performed by unconditional logistic regression.
  
  
  RESULTS
  Two thousand six hundred twenty one diabetes patients with a fracture following the diabetes diagnosis and with information on medication use were included. Of these, 229 died. In a multivariate analysis, statin use [n = 1,106 (42%) statin users, odds ratio (OR) = 0.60, 95% confidence interval, p = 0.012] decreased the risk of dying subsequent to a fracture. Male gender (OR = 1.57, p = 0.005), increasing age (OR = 1.08, p < 0.001), a diagnosis of retinopathy (OR = 2.12, p = 0.008), heart failure (OR = 1.68, p = 0.004), and use of glucocorticoids (OR = 2.22, p = 0.001) were associated with an increased risk of death. None of the antidiabetics: biguanides, glucagon-like receptor agonists, β-cell stimulants, glitazones, and insulin were associated with mortality.
  
  
  CONCLUSIONS
  Co-morbidity reflected by late onset complications, heart failure, and glucocorticoid use was associated with an increased risk of mortality subsequent to a fracture. Statin use may reduce mortality subsequent to a fracture in diabetes patients. Clinical trials are needed to determine whether diabetes patients with a fracture should initiate statin treatment.
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Sidse
authors.initials: S
authors.lastname: Westberg-Rasmussen
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Aarhus , Denmark ; Department of Clinical Medicine, Aalborg University , Aalborg , Denmark ; Department of Endocrinology, Aalborg University , Aalborg , Denmark.
authors.forename: Jakob
authors.initials: J
authors.lastname: Starup-Linde
authors.affiliation: Department of Endocrinology and Internal Medicine, Aarhus University Hospital , Aarhus , Denmark.
authors.forename: Søren
authors.initials: S
authors.lastname: Gregersen
authors.affiliation: Department of Clinical Medicine, Aalborg University , Aalborg , Denmark ; Department of Endocrinology, Aalborg University , Aalborg , Denmark.
authors.forename: Peter
authors.initials: P
authors.lastname: Vestergaard
keywords: antidiabetics; diabetes mellitus; fracture; mortality; statins