Friday, January 04, 2013 Adults With Diabetes at Greater Risk for Fracture Hospitalization Adults diagnosed with diabetes are at significantly increased risk for fracture-related hospitalization, says a Medscape Medical News article based on the results from an analysis of data from a large, community-based study. More than 15,100 patients between 45 and 64 years old participated in the Atherosclerosis Risk in Communities (ARIC) study, a 4-community study that began in 1987. There were a total of 1,078 fracture-related hospitalizations during the 20-year follow-up period. (Only fractures that resulted in inpatient hospitalization were captured in ARIC.) At baseline, 1,195 participants had been diagnosed with diabetes based on self-report, and 605 had undiagnosed diabetes according to their measured serum glucose values. Compared with the 13,340 study participants without diabetes, the incidence of fracture-related hospitalization was significantly greater among the group with diagnosed diabetes (6.6 vs 3.9 per 1,000 person-years of follow-up). The incidence of fracture hospitalization was higher among those with diagnosed diabetes compared with those without diabetes for all age groups. However, the fracture risk was not increased among those with undiagnosed diabetes compared with those without diabetes, the article says. After adjustment for the covariates, diagnosed diabetes still was associated with a significantly increased risk for fracture hospitalization, with a hazard ratio (HR) of 1.74. However, also in the fully adjusted analysis, the fracture risk among those with undiagnosed diabetes was similar to that for those participants without diabetes (HR 1.12). There also was a significant relationship with glycemic control. After adjustment, participants with diagnosed diabetes who had hemoglobin A1c values of 8% or greater had a significantly greater risk for fracture hospitalization than did those with A1c values less than 8% (HR 1.63). After further adjustment for diabetes medication use that risk was reduced (HR 1.50). The authors say further studies are needed to understand if exercise interventions or strategies to improve glycemic control while minimizing hypoglycemic episodes may prevent fractures among people with diabetes. The study was published online December 17 in Diabetes Care.