Risk of fragility fractures in obesity and diabetes: a retrospective analysis on a nation-wide cohort
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ORIGINAL ARTICLE
Risk of fragility fractures in obesity and diabetes: a retrospective analysis on a nation-wide cohort G. Adami 1 A. Fassio 1
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& D. Gatti & M. Rossini & G. Orsolini & F. Pollastri & E. Bertoldo & O. Viapiana & F. Bertoldo & A. Giollo &
Received: 15 April 2020 / Accepted: 24 June 2020 # International Osteoporosis Foundation and National Osteoporosis Foundation 2020
Abstract Summary This study aims to investigate the role of obesity and diabetes on bone health in a nation-wide cohort of women with high risk of fracture. Introduction The role of obesity and diabetes on fracture risk is yet poorly understood. Body mass index (BMI) and bone mineral density (BMD) are strongly correlated; however, patients with elevated BMI are not protected against fractures, configuring the obesity paradox. A similar controversial association has been also found in diabetic patients. Herein, we present a retrospective analysis on 59,950 women. Methods Using a new web-based fracture risk-assessment tool, we have collected demographic (including BMI), densitometric, and clinical data (including history of vertebral or hip and non-vertebral, non-hip fractures, presence of comorbidities). We performed a propensity score generation with 1:1 matching for patients in the obese (BMI ≥ 30) and non-obese (BMI < 30) groups, in the diabetics and non-diabetics. Propensity score estimates were estimated using a logistic regression model derived from the clinical variables: age, lumbar spine T-score, and femoral neck T-score. Results We found an association between diabetes and fractures of any kind (OR 1.3, 95% CI 1.1–1.4 and 1.3, 95% CI 1.2–1.5 for vertebral or hip fractures and non-vertebral, non-hip fractures, respectively). Obesity, on the other hand, was significantly associated only with non-vertebral, non-hip fractures (OR 1.3, 95% CI 1.1–1.6). To estimate the individual effect of obesity and diabetes on bone health, we ran sensitivity analyses which included obese non-diabetic patients and non-obese diabetic patients, respectively. Conclusions Non-obese diabetics had the highest risk of vertebral or hip fracture, whereas obese non-diabetics predominantly had non-vertebral, non-hip fracture’s risk. These results should raise awareness in clinical practice when evaluating diabetic and/ or obese patients. Keywords Body mass index (BMI) . Diabetes . Fractures . Obesity . Osteoporosis
Introduction Osteoporosis is characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture [1]. Fragility fractures are the consequence of osteoporosis * G. Adami [email protected] 1
Rheumatology Unit, University of Verona, Pz Scuro 10, 37134 Verona, Italy
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Bone Metabolism and Osteoncology Unit, University of Verona, Verona, Italy
and represent an increasing burden affecting not only the quality of life and mortality of osteoporotic patients but also on healthcare systems [2]. Identification and optimal profiling of the su
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