Endocrine Abstracts

Introduction: Patients with diabetes have an increased risk of low-energy bone fractures (LEF). Traditional clinical risk factors and bone mineral densitometry underestimate LEF risk in diabetics. We aim to evaluate the frequency of LEF and associated risk factors in the diabetic Portuguese population.

Methods: National, cross-sectional and population-based study to describe the prevalence of self-reported LEF in diabetic subjects over 40 years-old. Estimates were computed as weighted proportions/means, considering sample design. Multivariate logistic regression models were used to assess predictors of LEF in the diabetic.

Results: In a national cohort of 10 661 people, 7675 subjects were over 40 years-old, of which 1173 were diabetic. Compared to nondiabetic, diabetic patients were older (mean age 66.0±11.49 years-old; 55.8% female), more overweight or obese (81.1% vs. 61.3%) and more frequently reported osteoporosis (20.4% vs. 15.4%) and falls in the previous 12 months (32.4% vs. 22.9%). Estimated prevalence of self-reported LEF was 16.2% (95% CI: 13.68–19.13, n=203) among the diabetic, compared to 13.3% (95% CI: 12.14–14.57, n=931) in nondiabetic (crude OR for the association between diabetes and LEF: 1.26, 95% CI: 1.01–1.58, P=0.045; in women, adjusted OR: 1.41, 95% CI: 1.05–1.89; in men, adjusted OR: 0.86, 95% CI: 0.57–1.31, P=0.481; P-value for the interaction between diabetes and gender: 0.008). In the diabetic patients, LEF were more frequent among women and increased with age; LEF of distal forearm were the most prevalent (13.9%, 95% CI: 9.26–20.28), followed by hip (5.2%, 95% CI: 2.54–10.49) and vertebral fractures (3.2%, 95% CI: 1.35–7.59). A third of the diabetic (95% CI: 25.80–35.0) reported at least one major LEF (hip, vertebral or distal forearm) and 70% (95% CI: 65.39–74.36) in other sites. Self-reported LEF were associated with female gender (adjusted OR 1.66, 95% CI: 1.07–2.56, P=0.023) and the occurrence of falls in the previous 12 months (adjusted OR 1.72, 95% CI: 1.12–2.63, P=0.013) in the diabetic subjects.

Conclusion: Diabetics reported more falls and had a higher prevalence of self-reported LEF than nondiabetic. Female gender and falls were associated with LEF in the diabetic. Our findings emphasize the need for fracture and falls preventive measures in diabetic patients.