ArticlePLoS medicine2023
Risk of fracture in adults with type 2 diabetes in Sweden: A national cohort study.
Article in PLoS medicine, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
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Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 36 citations in OpenAlex.
- Association between type 2 diabetes and site-specific fracture risk: A systematic review and meta-analysis of cohort studies including over 13 million participants.Diabetic medicine : a journal of the British Diabetic Association · 2026Pooled it
- Association of type 2 diabetes with osteoporosis and fracture risk: A systematic review and meta-analysis.Medicine · 2025Pooled it
- The Association Between Type 2 Diabetes and Bone Microarchitecture Assessed by HR-pQCT.Calcified tissue international · 2026Article
- Age at diabetes diagnosis and fracture risk in women: a cohort study from the Australian Longitudinal Study on Women's Health.Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA · 2025Article
- Type 1 and 2 diabetes mellitus: comprehensive fracture risk relationships in UK Biobank.Journal of bone and mineral research : the official journal of the American Society for Bone and Mineral Research · 2025Article
- Degree of Joint Risk Factor Control and Incident Fracture Outcomes in Individuals With Type 2 Diabetes.The Journal of clinical endocrinology and metabolism · 2025Article
- Diabetic bone fragility through advanced glycation end product-collagen axis: Mechanisms and therapy of sodium glucose cotransporter 2 inhibitors.World journal of diabetes · 2025Review
- New Aspects of the Pathophysiology of Diabetic Bone Fragility - Type 2 Diabetes Mellitus as a Disease of Accelerated Aging.Current osteoporosis reports · 2025Review
- The Function of Myostatin in Ameliorating Bone Metabolism Abnormalities in Individuals with Type 2 Diabetes Mellitus by Exercise.Current issues in molecular biology · 2025Review
- Article
- Association of baseline osteocalcin and femoral neck bone mineral density in healthy women with future risk of fractures, cardiovascular disease, diabetes and death.Frontiers in endocrinology · 2025Article
- The Role of Antidiabetic Drugs in Bone Health: Assessing the Risk of Osteoporosis Subtypes and Fractures Using Mendelian Randomization.Orthopedic research and reviews · 2025Article
- Article
- Bone microarchitecture and strength assessed by HRpQCT in individuals with type 2 diabetes and prediabetes: the Maastricht study.JBMR plus · 2024Article
- Type 2 Diabetes and Fracture Risk in Older Women.JAMA network open · 2024Observational
- Bone metabolism in diabetes: a clinician's guide to understanding the bone-glucose interplay.Diabetologia · 2024Review
- Bone Health in Patients With Type 2 Diabetes.Journal of the Endocrine Society · 2024Article
- Age and sex are excellent predictors of bone complications in patients with type 2 diabetes with no history of osteoporotic fracture or treatment for osteoporosis.The Journal of international medical research · 2024Article
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Authors and funding
6 authors at 3 institutions in 2 countries.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundType 2 diabetes mellitus (T2DM) is considered a risk factor for fracture but the evidence regarding the impact of T2DM on fracture risk is conflicting. The objective of the study was to determine if patients with T2DM have increased fracture risk and if T2DM-related risk factors could be identified. METHODS AND
findingsIn this national cohort study in Sweden, we investigated the risk of fracture in 580,127 T2DM patients, identified through the national diabetes register including from both primary care and hospitals, and an equal number of population-based controls without diabetes matched for age, sex, and county from 2007 to 2017. The mean age at entry was 66.7 years and 43.6% were women. During a median follow-up time of 6.6 (interquartile range (IQR) 3.1 to 9.8) years, patients with T2DM had a marginally but significantly increased risk of major osteoporotic fracture (MOF) (hazard ratio (HR) 1.01 (95% confidence interval [CI] 1.00 to 1.03)) and hip fracture (HR 1.06 (95% CI 1.04 to 1.08)) compared to controls, associations that were only minimally affected (HR 1.05 (95% CI 1.03 to 1.06) and HR 1.11 (95% CI 1.09 to 1.14), respectively) by multivariable adjustment (age, sex, marital status, and an additional 20 variables related to general morbidity, cardiovascular status, risk of falls, and fracture). In a multivariable-adjusted Cox model, the proportion of the risk for all fracture outcomes (Heller's R2) explained by T2DM was below 0.1%. Among the T2DM patients, important risk factors for fracture were a low BMI (<25 kg/m2), long diabetes duration (≥15 years), insulin treatment, and low physical activity. In total, 55% of the T2DM patients had none of these risk factors and a significantly lower fracture risk than their respective controls. The relatively short mean duration of T2DM and lack of bone density data, constitute limitations of the analysis.
conclusionIn this study, we observed only a marginally increased fracture risk in T2DM, a condition that explained less than 0.1% of the fracture risk. Consideration of the herein identified T2DM-related risk factors could be used to stratify T2DM patients according to fracture risk.
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