title: Type 1 diabetes is associated with an increased risk of fracture across the life span: a population-based cohort study using The Health Improvement Network (THIN).
abstract: OBJECTIVE
  This study was conducted to determine if type 1 diabetes is associated with an increased risk of fracture across the life span.
  
  
  METHODS
  This population-based cohort study used data from The Health Improvement Network (THIN) in the U.K. (data from 1994 to 2012), in which 30,394 participants aged 0-89 years with type 1 diabetes were compared with 303,872 randomly selected age-, sex-, and practice-matched participants without diabetes. Cox regression analysis was used to determine hazard ratios (HRs) for incident fracture in participants with type 1 diabetes.
  
  
  RESULTS
  A total of 334,266 participants, median age 34 years, were monitored for 1.9 million person-years. HR were lowest in males and females age <20 years, with HR 1.14 (95% CI 1.01-1.29) and 1.35 (95% CI 1.12-1.63), respectively. Risk was highest in men 60-69 years (HR 2.18 [95% CI 1.79-2.65]), and in women 40-49 years (HR 2.03 [95% CI 1.73-2.39]). Lower extremity fractures comprised a higher proportion of incident fractures in participants with versus those without type 1 diabetes (31.1% vs. 25.1% in males, 39.3% vs. 32% in females; P < 0.001). Secondary analyses for incident hip fractures identified the highest HR of 5.64 (95% CI 3.55-8.97) in men 60-69 years and the highest HR of 5.63 (95% CI 2.25-14.11) in women 30-39 years.
  
  
  CONCLUSIONS
  Type 1 diabetes was associated with increased risk of incident fracture that began in childhood and extended across the life span. Participants with type 1 diabetes sustained a disproportionately greater number of lower extremity fractures. These findings have important public health implications, given the increasing prevalence of type 1 diabetes and the morbidity and mortality associated with hip fractures.
authors.affiliation: Golisano Children's Hospital, University of Rochester School of Medicine and Dentistry, Rochester, NY david_weber@urmc.rochester.edu.
authors.forename: David R
authors.initials: DR
authors.lastname: Weber
authors.affiliation: Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Kevin
authors.initials: K
authors.lastname: Haynes
authors.affiliation: Stanford University School of Medicine, Stanford, CA.
authors.forename: Mary B
authors.initials: MB
authors.lastname: Leonard
authors.affiliation: Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Willi
authors.affiliation: Children's Hospital of Philadelphia, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.
authors.forename: Michelle R
authors.initials: MR
authors.lastname: Denburg
mesh_terms: D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D003922:Diabetes Mellitus, Type 1 / Q000150:complications* / Q000453:epidemiology; D004812:Epidemiologic Methods; D005260:Female; D005598:Fractures, Spontaneous / Q000453:epidemiology / Q000209:etiology*; D006620:Hip Fractures / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017678:Sex Distribution; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult