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Open Access Research article

Fractures are increased and bisphosphonate use decreased in individuals with insulin-dependent diabetes: a 10 year cohort study

Lisa-Ann Fraser14*, Alexandra Papaioannou3, Jonathan D Adachi3, Jinhui Ma2, Lehana Thabane2 and CaMos Research Group

Author Affiliations

1 Department of Medicine, University of Western Ontario, London, Ontario, Canada

2 Department of Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada

3 Department of Medicine, McMaster University, Hamilton, Ontario, Canada

4 Division of Endocrinology and Metabolism, St. Joseph’s Hospital, 268 Grosvenor Street, London N6A 4 V2 Ontario, Canada

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BMC Musculoskeletal Disorders 2014, 15:201  doi:10.1186/1471-2474-15-201

Published: 11 June 2014

Abstract

Background

Individuals with diabetes have been found previously to be at increased risk of non-traumatic fracture. However, it is unclear if these individuals are being identified and treated for osteoporosis.

Methods

7753 Canadians over 50 years of age were followed prospectively for 10 years. 606/7753 (7.8%) of had diabetes; 98 were insulin-dependent and 508 were not. Using a cox proportional hazards model, we assessed the association between diabetes status and incident non-traumatic fracture. Using logistic regression we identified factors associated with bisphosphonate use over the 10 year period of study.

Results

Mean (SD) age of participants was 66.7(9.4) years and 72% were female. Those with diabetes had higher BMD T-scores at baseline, with a mean (SD) femoral neck T-Score of -0.97 (1.06), compared to -1.24 (0.99) in the general cohort. The adjusted hazard ratio (HR) for incident non-traumatic fracture in individuals with insulin-dependent diabetes over the 10 year study period was 2.50 (95% confidence interval [CI] 1.60, 3.90; p < 0.001). Despite this increased fracture rate, individuals with diabetes (insulin-dependent or non-insulin-dependent) were less likely to be on bisphosphonate therapy at any point over 10 years of prospective follow up compared to other CaMos subjects (odds ratio [OR]: 0.59; 95% CI 0.46-0.75, p < 0.001).

Conclusions

Despite the increased risk of non-traumatic fracture associated with insulin-dependent diabetes, we that found individuals with diabetes are less likely to be treated with a bisphosphonate than those without diabetes. These findings point to a possible care gap in the treatment of non-traumatic fractures in individuals with diabetes in Canada.

Keywords:
Fracture; Diabetes; Insulin; Care gap; Treatment; Osteoporosis