Clinical Fractures Among Older Men With Diabetes Are Mediated by Diabetic Complications
Clinical Fractures Among Older Men With Diabetes Are Mediated by Diabetic Complications
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DOI：
10.1210/jc.2017-01593
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发表时间：
2018-01-01
影响因子：
5.8
通讯作者：
Colon-Emeric, Cathleen
中科院分区：
文献类型：
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作者：
Lee, Richard H.;Sloane, Richard;Colon-Emeric, Cathleen
简介：老年妇女中的2型糖尿病与骨密度增加有关，但矛盾的是与骨折风险增加有关。老年男性中的研究结果各不相同，潜在的机制尚未完全阐明。方法：回顾性研究的男性退伍军人65至99岁谁收到初级保健的退伍军人健康管理局从2000年至2010年，使用行政数据从所有146退伍军人健康管理医疗中心链接到医疗保险和医疗补助服务中心医疗保险费的服务数据。糖尿病相关风险的潜在介导因素进行了评估，使用负二项回归模型与任何临床骨折和髋部fraction.Results的结果：2,798,309退伍军人包括在队列中，900,402（32.3%）有糖尿病的诊断。调整年龄、种族、民族、体重指数、酒精和烟草使用、类风湿性关节炎和皮质类固醇使用后，与糖尿病相关的任何临床骨折的风险为1.22（95%置信区间，1.21至1.23），髋部骨折的风险为1.21（95%置信区间，1.19至1.23）。重要的中介因素包括周围神经病变，心血管疾病，充血性心力衰竭，与45.5%的糖尿病相关的骨折风险解释这些diagnosis.Conclusions：老年男性退伍军人糖尿病有22%的风险增加事件的临床骨折相比，那些没有。这种风险的很大一部分是由糖尿病相关的合并症，特别是周围神经病变和充血性心力衰竭解释的。这些中介因素的识别表明可能的机制，以及潜在的干预措施。
Introduction: Type 2 diabetes mellitus among older women has been associated with increased bone mineral density, but paradoxically with increased fracture risk. Findings among older men have varied, and potential mechanisms have not been fully elucidated.Methods: A retrospective study of male veterans 65 to 99 years of age who received primary care in the Veterans Health Administration from 2000 to 2010, using administrative data from all 146 Veterans Health Administration medical centers linked to Centers for Medicare and Medicaid Services Medicare fee-for-service data. Potential mediating factors of the diabetes-associated risk were evaluated using negative binomial regression models with the outcomes of any clinical fracture and hip fracture.Results: Of 2,798,309 Veterans included in the cohort, 900,402 (32.3%) had a diagnosis of diabetes. After adjusting for age, race, ethnicity, body mass index, alcohol and tobacco use, rheumatoid arthritis, and corticosteroid use, the risk of any clinical fracture associated with diabetes was 1.22 (95% confidence interval, 1.21 to 1.23) and that of hip fracture was 1.21 (95% confidence interval, 1.19 to 1.23). Significant mediating factors included peripheral neuropathy, cardiovascular disease, and congestive heart failure, with 45.5% of the diabetes-associated fracture risk explained by these diagnoses.Conclusions: Older male Veterans with diabetes have a 22% increased risk of incident clinical fracture compared with those without. A significant portion of this risk is explained by diabetes-related comorbidities, specifically peripheral neuropathy and congestive heart failure. Identification of these mediating factors suggests possible mechanisms, as well as potential interventions.