title: Fracture risk in patients with newly diagnosed type 2 diabetes: a retrospective database analysis in primary care.
abstract: OBJECTIVE
  It is unclear whether fracture risk is increased in newly diagnosed type 2 diabetes patients. In addition, fracture risk of various sites (hip, spine, upper extremity) was analysed.
  
  
  METHODS
  The study included 299,104 primary care patients from 1,072 practices who received a first type 2 diabetes diagnosis during the index period (01/2000-12/2013) (Disease Analyser, Germany). Furthermore, 299,104 non-diabetic controls were included after individual matching (1:1) to diabetes cases on age, sex, type of health insurance (private or statutory) and index date (visit at date of first diabetes diagnosis). Cumulative incidence of fractures was estimated for 10 years after index date using product-limit methods. Hazard ratios were calculated using Cox regression models adjusting for comorbidity.
  
  
  RESULTS
  Cumulative 10-year incidence of any, hip, spine, wrist/hand, forearm, and upper arm/shoulder fractures were 15.4%, 2.9%, 2.6%, 5.1%, 2.3%, and 2.3% in diabetes patients and 13.1%, 2.0%, 2.1%, 4.6%, 2.2%, and 1.7% in controls (log-rank test: all p<0.001, except wrist/hand p=0.56, forearm: p=0.54), respectively. In multivariate Cox regression models, newly diagnosed type 2 diabetes was related to an significantly increased risk of any fracture (adjusted hazard ratio, HR, 95% CI: 1.36, 1.32-1.40), as well as for hip (1.56, 1.45-1.67), spine (1.37, 1.28-1.47), wrist/hand (1.15, 1.03-1.27), forearm (1.12, 1.05-1.20), and upper arm/shoulder (1.61, 1.49-1.74) fractures.
  
  
  CONCLUSIONS
  Already few years after diabetes diagnosis, type 2 diabetes patients more frequently experienced overall, hip, spine, and upper extremity fractures, respectively. The underlying mechanisms need to be further explored in order to prevent fractures among patients with type 2 diabetes.
authors.affiliation: German Diabetes Center, Institute for Biometrics and Epidemiology, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Rathmann
authors.affiliation: IMS Health, Frankfurt, Germany. Electronic address: kkostev@de.imshealth.com.
authors.forename: Karel
authors.initials: K
authors.lastname: Kostev
mesh_terms: D000368:Aged; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012306:Risk
keywords: Disease Analyzer; Fracture risk; Osteoporosis; Primary care; Type 2 diabetes