Objective: To determine clinical diabetes-related risk factors for fragility fractures in type 1 diabetes (T1D). Research design and methods: History of bone fragility fractures occurring after T1D diagnosis was assessed by questionnaire in this cross-sectional study in 600 T1D subjects. Glycated hemoglobin A1c (HbA1c)over the previous 5 years was used as an index of long-term glycemic control; complications were adjudicated by physician assessment. Multinomial logistic regression models were used to assess the associations between diabetes-related risk factors and fracture history. Results: One-hundred-eleven patients (18.5%)reported at least one fracture; of these 73.8% had only one and 26.2% had more than one fracture. Average age was 41.9 ± 12.8 years, with even gender distribution; disease duration was 19.9 ± 12.0 years; and BMI was 24.4 ± 3.7 kg/m2. The 5-year average HbA1c was 7.6 ± 1.0% (60 mmol/mol). In adjusted models, reduced risk for 1 fracture was found in those with higher creatinine clearance rate (CCr)(RRR 0.22 [95% CI: 0.06–0.83]for 1 unit increase in lnCCr, p = 0.03)and increased risk in those with neuropathy (RRR 2.57 [1.21–5.46], p = 0.01). Increased risk for ≥2 fractures was found in subjects in the highest tertile of HbA1c (≥7.9%)compared with the lowest tertile (≤7.17%)(RRR 3.50 [1.04–11.7], p = 0.04)and of disease duration (≥26 years versus <14 years)(RRR 7.59 [1.60–35.98], p = 0.01). Conclusions: Poor glycemic control and long exposure to the disease are independent diabetes-related risk factors for multiple bone fractures in T1D.

Leanza, G., Maddaloni, E., Pitocco, D., Conte, C., Palermo, A., Maurizi, A. R., Pantano, A. L., Suraci, C., Altomare, M., Strollo, R., Manfrini, S., Pozzilli, P., Schwartz, A. V., Napoli, N., Risk factors for fragility fractures in type 1 diabetes, <<BONE>>, 2019; 125 (N/A): 194-199. [doi:10.1016/j.bone.2019.04.017] [https://hdl.handle.net/10807/221591]

Risk factors for fragility fractures in type 1 diabetes

Leanza, G.;Pitocco, D.;Palermo, A.;
2019

Abstract

Objective: To determine clinical diabetes-related risk factors for fragility fractures in type 1 diabetes (T1D). Research design and methods: History of bone fragility fractures occurring after T1D diagnosis was assessed by questionnaire in this cross-sectional study in 600 T1D subjects. Glycated hemoglobin A1c (HbA1c)over the previous 5 years was used as an index of long-term glycemic control; complications were adjudicated by physician assessment. Multinomial logistic regression models were used to assess the associations between diabetes-related risk factors and fracture history. Results: One-hundred-eleven patients (18.5%)reported at least one fracture; of these 73.8% had only one and 26.2% had more than one fracture. Average age was 41.9 ± 12.8 years, with even gender distribution; disease duration was 19.9 ± 12.0 years; and BMI was 24.4 ± 3.7 kg/m2. The 5-year average HbA1c was 7.6 ± 1.0% (60 mmol/mol). In adjusted models, reduced risk for 1 fracture was found in those with higher creatinine clearance rate (CCr)(RRR 0.22 [95% CI: 0.06–0.83]for 1 unit increase in lnCCr, p = 0.03)and increased risk in those with neuropathy (RRR 2.57 [1.21–5.46], p = 0.01). Increased risk for ≥2 fractures was found in subjects in the highest tertile of HbA1c (≥7.9%)compared with the lowest tertile (≤7.17%)(RRR 3.50 [1.04–11.7], p = 0.04)and of disease duration (≥26 years versus <14 years)(RRR 7.59 [1.60–35.98], p = 0.01). Conclusions: Poor glycemic control and long exposure to the disease are independent diabetes-related risk factors for multiple bone fractures in T1D.
Inglese
Leanza, G., Maddaloni, E., Pitocco, D., Conte, C., Palermo, A., Maurizi, A. R., Pantano, A. L., Suraci, C., Altomare, M., Strollo, R., Manfrini, S., Pozzilli, P., Schwartz, A. V., Napoli, N., Risk factors for fragility fractures in type 1 diabetes, <<BONE>>, 2019; 125 (N/A): 194-199. [doi:10.1016/j.bone.2019.04.017] [https://hdl.handle.net/10807/221591]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10807/221591
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