title: Association of type 2 diabetes and an inflammatory marker with incident bone fracture among a Japanese cohort.
abstract: OBJECTIVE
  There are various causes of incident bone fracture. Not only aging, low bone mineral density and history of previous fracture, but also diabetes mellitus and inflammation are regarded as risk factors for fracture. The purpose of the present study was to verify the association of glycemic control or one inflammatory marker with incident fracture in a large-scale Japanese cohort.
  
  
  METHODS
  The present study was carried out at the Hiroshima Atomic Bomb Casualty Council and included 6,556 participants (2,785 men and 3,771 women, aged 55-87 years) who underwent annual health examinations and were followed for 7.4 years. Information about incident fractures was collected at interviews. Participants were classified into three groups: normal, borderline and diabetes mellitus according to glycohemoglobin levels (treated diabetes patients were included in the diabetes mellitus group). Furthermore, participants were classified into four additional groups by glycemic control (diabetes mellitus or non-diabetes mellitus) and C-reactive protein (CRP) levels (low or high). Hazard ratios (HRs) of diabetes mellitus, CRP and their combined risk of incident fracture were evaluated.
  
  
  RESULTS
  After adjusting for age, bone mineral density and previous fracture, CRP was associated with increased fracture risk (in men HR 1.04, 95% confidence interval [CI]: 1.003-1.06; in women HR 1.07, 95% CI: 1.03-1.13), and diabetes mellitus predicted fracture risk in men (HR 1.31, 95% CI: 1.02-1.51). Fracture risk was significantly higher among the diabetes mellitus with high CRP group compared with the non-diabetes mellitus with low CRP group (in men HR 1.47, 95% CI: 1.02-1.98; in women HR 1.41, 95% CI: 1.04-1.92).
  
  
  CONCLUSIONS
  Among a Japanese cohort, CRP measurements were helpful to detect high fracture risk in patients with type 2 diabetes mellitus.
authors.affiliation: Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Mitama
authors.affiliation: Health Management & Promotion Center, Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan.
authors.forename: Saeko
authors.initials: S
authors.lastname: Fujiwara
authors.affiliation: Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Masayasu
authors.initials: M
authors.lastname: Yoneda
authors.affiliation: Health Management & Promotion Center, Hiroshima Atomic Bomb Casualty Council, Hiroshima, Japan.
authors.forename: Sakurako
authors.initials: S
authors.lastname: Kira
authors.affiliation: Department of Molecular and Internal Medicine, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan.
authors.forename: Nobuoki
authors.initials: N
authors.lastname: Kohno
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood; D015519:Bone Density; D002097:C-Reactive Protein / Q000378:metabolism*; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D005260:Female; D050723:Fractures, Bone / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D006801:Humans; D007249:Inflammation / Q000097:blood / Q000150:complications / Q000453:epidemiology*; D007564:Japan; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein
keywords: C-reactive protein; Diabetes mellitus; Incident bone fracture