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The doubled burden of diabetic bone disease: hip fracture and post-hip fracture mortality.

糖尿病骨病的双重负担: 髋部骨折和髋部骨折后死亡率。

  • 影响因子:5.04
  • DOI:10.1530/EJE-20-1155
  • 作者列表:"Behanova M","Haschka J","Zwerina J","Wascher TC","Reichardt B","Klaushofer K","Kocijan R
  • 发表时间:2021-05-01
Abstract

Objective:Patients with diabetes have an increased risk of osteoporosis and shorter life expectancy. Hip fracture (HF) is the most serious consequence of osteoporosis and is associated with increased mortality risk. We aimed to assess the association of antidiabetic medications with HF and the post-hip fracture mortality risk among diabetic patients ≥50 years. Design:In this nationwide case-control study 53 992 HF cases and 112 144 age-, sex- and region-matched non-hip fracture controls were analyzed. A cohort of hip-fractured diabetic patients were followed-up for an all-cause mortality. Methods:We defined three groups of diabetic patients based on a prescription of antidiabetic medications: group 1 treated with insulin monotherapy (G1DM), group 2 (G2DM) treated with blood glucose-lowering drugs (BGLD) only, group 3 on a combined BGLD and insulin therapy (G3DM). We applied logistic regression and Cox regression. Results:We identified 2757 G1DM patients, 15 310 G2DM patients, 3775 G3DM patients and 144 294 patients without any antidiabetic treatment. All three groups of diabetic patients had increased odds of HF compared to controls. G1DM patients aged 50-64 years (aOR: 4.80, 95% CI: 3.22-7.17) and G3DM patients (aOR: 1.39, 95% CI: 1.02-1.88) showed the highest HF odds, whereas G2DM patients had 18% decrease in HF odds than their non-diabetic controls (aOR: 0.82, 95% CI: 0.69-0.99). All diabetic patients had increased post-hip fracture mortality risk compared to non-diabetic controls. The highest mortality hazard was observed in G1DM patients, being greater for women than men (HR: 1.71, 95% CI: 1.55-1.89 and HR: 1.44, 95% CI: 1.27-1.64, respectively). Conclusions:Antidiabetic medications increase the probability of HF. Diabetic patients, who sustained HF have a higher mortality risk than non-diabetic patients.

摘要

目的: 糖尿病患者患骨质疏松症的风险增加,预期寿命缩短。髋部骨折 (HF) 是骨质疏松症最严重的后果,并与死亡风险增加相关。我们的目的是在 ≥ 50岁的糖尿病患者中评估抗糖尿病药物与HF和髋部骨折后死亡风险的相关性。 设计: 在这项全国性病例对照研究中,分析了53 992例HF病例和112 144例年龄、性别和地区匹配的非髋部骨折对照。对一组髋部骨折的糖尿病患者进行全因死亡率随访。 方法: 我们根据抗糖尿病药物处方定义了三组糖尿病患者: 组1接受胰岛素单药治疗 (G1DM),组2 (G2DM) 仅接受降血糖药物治疗 (BGLD),组3接受BGLD和胰岛素联合治疗 (G3DM)。我们应用了logistic回归和Cox回归。 结果: 我们确定了2757例G1DM患者,15 310例G2DM患者,3775例G3DM患者和144 294例未接受任何抗糖尿病治疗的患者。与对照组相比,所有三组糖尿病患者的HF几率增加。年龄在50-64岁的G1DM患者 (aOR: 4.80,95% CI: 3.22-7.17) 和G3DM患者 (aOR: 1.39,95% CI: 1.02-1.88) 表现出最高的HF几率,而G2DM患者比他们的非糖尿病对照 (aOR: 18%,95% CI: 0.69-0.99)。与非糖尿病对照组相比,所有糖尿病患者的髋部骨折后死亡风险增加。G1DM患者的死亡风险最高,女性高于男性 (HR: 1.71,95% CI: 1.55-1.89和HR: 1.44,95% CI: 1.27-1.64)。 结论: 抗糖尿病药物增加HF的概率。患有心力衰竭的糖尿病患者比非糖尿病患者具有更高的死亡风险。

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