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Risk of Fracture in Women with Type 2 Diabetes: the Women’s Health Initiative Observational Study

Departments of Epidemiology and Prevention and Internal Medicine (D.E.B.), Wake Forest University School of Medicine, Winston-Salem, North Carolina 27157; Fred Hutchinson Cancer Research Center (J.C.L.), Seattle, Washington 98109; Department of Epidemiology and Biostatistics (A.V.S.), University of California San Francisco, San Francisco, California 94105; Department of Epidemiology (E.S.S.), University of Pittsburgh, Pittsburgh, Pennsylvania 15213; Department of Internal Medicine (J.R.), University of California, Davis, Davis, California 95817; Department of Geriatric Medicine (B.L.R.), University of Hawaii at Manoa, Honolulu, Hawaii 96817; Department of Preventive Medicine (K.C.J.), University of Tennessee Health Science Center, Memphis Tennessee 38105; and HealthPartners Research Foundation (K.L.M.), Minneapolis, Minnesota 55440-1524

Address all correspondence and requests for reprints to: Denise E. Bonds, M.D., M.P.H., Department of Epidemiology and Prevention, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina 27157. E-mail: dbonds{at}wfubmc.edu.

Context: Some but not all studies have shown higher rates of fracture in individuals with type 2 diabetes.

Objective: The objective of the study was to determine the risk of fracture in postmenopausal women with type 2 diabetes and determine whether risk varies by fracture site, ethnicity, and baseline bone density.

Design, Setting, and Participants: Women with clinically diagnosed type 2 diabetes at baseline in the Women’s Health Initiative Observational Cohort, a prospective study of postmenopausal women (n = 93,676), were compared with women without diagnosed diabetes and risk of fracture overall and at specific sites determined.

Main Outcome Measures: All fractures and specific sites separately (hip/pelvis/upper leg; lower leg/ankle/knee; foot; upper arm/shoulder/elbow; lower arm/wrist/hand; spine/tailbone) were measured. Bone mineral density (BMD) in a subset also was measured.

Results: The overall risk of fracture after 7 yr of follow-up was higher in women with diabetes at baseline after controlling for multiple risk factors including frequency of falls [adjusted relative risk (RR) 1.20, 95% confidence interval (CI) 1.11–1.30]. In a subsample of women with baseline BMD scores, women with diabetes had greater hip and spine BMD. The elevated fracture risk was found at multiple sites (hip/pelvis/upper leg; foot; spine/tailbone) among black women (RR 1.33, 95% CI 1.00–1.75) and women with increased baseline bone density (RR 1.26, 95% CI 0.96–1.66).

Conclusion: Women with type 2 diabetes are at increased risk for fractures. This risk is also seen among black and non-Hispanic white women after adjustment for multiple risk factors including frequent falls and increased BMD (in a subset).

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Diabetes and the Chance of Bone Fractures

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