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Submitted on March 20, 2006
Accepted on June 15, 2006
Departments of Epidemiology and Prevention and Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, North Carolina; Fred Hutchison Cancer Research Center, Seattle, Washington; Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California; Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania; Department of Internal Medicine, University of California at Davis, Davis, California; Department of Geriatric Medicine, University of Hawaii at Manoa, Honolulu, Hawaii; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis Tennessee; HealthPartners Research Foundation, Minneapolis, Minnesota
* To whom correspondence should be addressed. 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: To determine the risk of fracture in postmenopausal women with type 2 diabetes and to determine if 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). Bone mineral density in a subset.
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 RR 1.20, 95% CI 1.11-1.30). In a sub-sample of women with baseline bone mineral density (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 in 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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