Association of hip fractures with cardiometabolic-renal risk factors in Southern Chinese patients with type 2 diabetes - the Hong Kong Diabetes Register

Elaine Yun-Ning Cheung, Alice Pik-Shan Kong, Eric Siu-Him Lau, Elaine Yee-Kwan Chow, Andrea On-Yan Luk, Ronald Ching-Wan Ma, Tsz Ping Lam, Wayne Yuk-Wai Lee, Jack Chun-Yiu Cheng, Peter R Ebeling, Juliana Chung-Ngor Chan, Elaine Yun-Ning Cheung, Alice Pik-Shan Kong, Eric Siu-Him Lau, Elaine Yee-Kwan Chow, Andrea On-Yan Luk, Ronald Ching-Wan Ma, Tsz Ping Lam, Wayne Yuk-Wai Lee, Jack Chun-Yiu Cheng, Peter R Ebeling, Juliana Chung-Ngor Chan

Abstract

Introduction: Diabetes and bone health are closely related. We examined the incidence and risk factors of hip fractures in Chinese patients with type 2 diabetes (T2D).

Materials and methods: In this prospective cohort, we consecutively enrolled 22,325 adults with T2D above the age of 40 years in the Hong Kong Diabetes Register between 1994 and 2015 with crude hip fracture incidence rate censored in 2017.

Results: At baseline, the mean age of this cohort was 60.9 ± 10.5 years (mean duration of diabetes 6 years, 52.4% male). During a mean ± standard deviation (SD) follow-up period of 8.7 ± 5.2 years with 193,553 person-years, 603 patients were hospitalized due to hip fractures with an incidence (95% confidence interval, CI) of 315.1 (290.4-341.3) per 100,000 person-years. On multivariable analysis with competing death risk adjusted, the independent hazard ratios (95% CI) for hip fractures in T2D were 2.01 (1.61-2.51) for female sex, 1.08 (1.07-1.09) for age, 0.93 (0.90-0.95) for body mass index, 1.52 (1.25-1.85) for albuminuria and 1.12 (1.02-1.23) for low density lipoprotein-cholesterol. In men, the 30-day, 1-year and 5-year post-hip fracture mortality rate (95% CI) were 5.8 (2.4-9.1) %, 29.2 (22.3-35.5) % and 65.9 (57.3-72.8) % respectively. The corresponding rates in women were 3.4 (1.6-5.1) %, 18.6 (14.7-22.4) %, and 46.8 (40.9-52.1) %.

Conclusions: Southern Chinese patients with T2D have a high risk of hip fracture associated with suboptimal cardiometabolic-renal risk factors and a high post-fracture mortality rate. The effects of improving modifiable risk factors on bone health warrants further evaluation.

Keywords: Cardiometabolic-renal risk factors; Hip fractures; Type 2 diabetes.

Conflict of interest statement

CNC is the Chief Executive Officer (on a pro‐bono basis) of Asia Diabetes Foundation, a charitable foundation established under The Chinese University of Hong Kong Foundation for developing the JADE Technology. JCNC has received research grants and/or honoraria for consultancy or giving lectures, from AstraZeneca, Bayer, Bristol‐Myers Squibb, Boehringer Ingelheim, Daiichi‐Sankyo, Eli‐Lilly, GlaxoSmithKline, Merck Serono, Merck Sharp & Dohme, Novo Nordisk, Pfizer, and Sanofi. APSK has received research grants and/or speaker honoraria from Abbott, Astra Zeneca, Eli‐Lilly, Merck Serono, Nestle, and Novo Nordisk. The proceeds have been donated to The Chinese University of Hong Kong, American Diabetes Association and other charity organizations to support diabetes research and education. Other authors declared no conflict of interest with this manuscript.

© 2021 The Authors. Journal of Diabetes Investigation published by Asian Association for the Study of Diabetes (AASD) and John Wiley & Sons Australia, Ltd.

Figures

Figure 1
Figure 1
Study flow including definitions of study cohorts and outcomes

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