Abstract
Background: Diabetes is associated with a high risk of fragility fracture. However, there are controversies regarding the effect of fluctuations in metabolic parameters on the risk of fracture. We aimed to investigate the associations of body weight or glucose variability or their combination with the risk of hip fracture in people with diabetes. Methods: A population-based cohort study with 480,539 subjects over 40 years who had undergone three or more health examinations was performed. The degree of variability was evaluated using variability independent of the mean (VIM, 100 × standard deviation / meanbeta), coefficient of variation (CV), and average real variability (ARV, average of the absolute differences between consecutive values). High variability was defined as having values in the highest quartile. Cox proportional hazards models were used to estimate the risk of hip fracture. Results: There were 2834 hip fracture events (0.59%) during the mean follow-up of 8.1 years. After multivariable adjustment for age, sex, alcohol consumption, smoking, regular exercise, income, glucose, body mass index, hemoglobin, estimated glomerular filtration rate, diabetes duration, diabetes treatment with multiple agents, and osteoporosis, the HRs (95% CI) of hip fracture were 1.36 (1.24–1.50) and 1.29 (1.16–1.43) for high body weight VIM and high glucose VIM, respectively. The HR (95% CI) of both high VIM group was 1.63 (1.44–1.83), suggesting an additive effect of variabilities in body weight and glucose. The results were consistent when using CV and ARV and in various sensitivity analyses. Conclusions: High variability in body weight and glucose levels is associated with an increased incidence rate and risk of hip fracture in people with diabetes.
Original language | English |
---|---|
Article number | 155135 |
Journal | Metabolism: Clinical and Experimental |
Volume | 129 |
DOIs | |
State | Published - Apr 2022 |
Bibliographical note
Funding Information:This study was performed using the database from the National Health Insurance System and the results do not necessarily represent the opinion of the National Health Insurance Corporation. This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. All data generated or analyzed during this study are included in this published article and its supplementary information files.
Publisher Copyright:
© 2022 Elsevier Inc.
Keywords
- Bone metabolism
- Diabetes
- Fracture
- Glycemic variability
- Weight change