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ArticleOsteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA2026

Diabetes progression and its association with fracture risk in type 2 diabetes.

Bongsung Kim, Kyu-Na Lee, Kyungdo Han, Mee Kyoung Kim

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Article in Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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4 authors.

Bongsung KimDepartment of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Kyu-Na LeeDepartment of Preventive Medicine and Public Health, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
Kyungdo HanDepartment of Statistics and Actuarial Science, Soongsil University, Seoul, Republic of Korea.
Mee Kyoung KimDivision of Endocrinology and Metabolism, Department of Internal Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, 1021 Tongil-Ro, Eunpyeong-Gu, Seoul, 03312, Republic of Korea. makung@catholic.ac.kr.ORCID http://orcid.org/0000-0003-3205-9114

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6 · The paper itself

Abstract

People with type 2 diabetes mellitus (T2DM) accumulate factors that weaken bone. In over two million adults, fracture risk rose stepwise as diabetes progressed, with the steepest increase for hip fractures. A simple progression score using routine clinical data may help flag patients who need earlier bone-protective care. PURPOSE: Patients with type 2 diabetes mellitus (T2DM) are often exposed to multiple factors contributing to bone fragility-such as poor glycemic control, long duration of exposure to hyperglycemia, and comorbidities. Because these factors often accumulate over time, we examined whether fracture risk increases with diabetes progression.

methodsWe analyzed data from 2,069,920 patients with T2DM from the Korean National Health Information Database who underwent health examinations in 2015-2016. Patients with a prior history of fractures or who died within one year were excluded. Diabetes progression was scored from 0 to 6 based on the number of oral glucose-lowering drugs, disease duration, insulin use, and presence of chronic kidney disease, cardiovascular disease (CVD), or diabetic retinopathy. Incident fractures were tracked until 2023 using ICD-10 codes.

resultsOver a median follow-up of 6.4 years, 169,595 fractures occurred, including 69,723 vertebral and 23,581 hip fractures. Each component of diabetes progression was independently associated with fracture risk (hazard ratios [HRs] ranging from 1.14 to 1.40). Insulin use (HR, 1.40; 95% confidence interval [CI]: 1.38-1.42) and CVD (HR, 1.26; 95% CI: 1.24-1.28) conferred notably higher risks. Fracture risk increased progressively with higher progression scores (HRs for score 4: 1.60; 95% CI: 1.56-1.64; HRs for score 5: 1.87; 95% CI: 1.78-1.96). The magnitude of increase was more pronounced for hip fractures.

conclusionThe risk of fractures increased incrementally in parallel with diabetes progression, most notably for hip fractures. Diabetes progression metrics may help identify patients at elevated fracture risk.

Indexed as

Bone fragilityDiabetes mellitusDiabetes progressionFractures, boneKorean National Health Information Database

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.