Association between hyperglycaemia and fracture risk in non-diabetic middle-aged and older Australians: a national, population-based prospective study (AusDiab)

Summary The association between pre-diabetes and fracture risk remains unclear. In this large cohort of middle-aged and older Australian men and women without diabetes, elevated 2-h plasma glucose and pre-diabetes were associated with a reduced 5-year risk of low trauma and all fractures in women, i...

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Bibliographic Details
Published in:Osteoporosis international 2010-12, Vol.21 (12), p.2067-2074
Main Authors: Gagnon, C, Magliano, D. J, Ebeling, P. R, Dunstan, D. W, Zimmet, P. Z, Shaw, J. E, Daly, R. M
Format: Article
Language:English
Subjects:
Adult
Aged
Anthropometry - methods
Australia - epidemiology
Biological and medical sciences
blood glucose
Blood Glucose - metabolism
Body Mass Index
Diabetes. Impaired glucose tolerance
Diseases of the osteoarticular system
Endocrine pancreas. Apud cells (diseases)
Endocrinology
Endocrinopathies
Epidemiologic Methods
Etiopathogenesis. Screening. Investigations. Target tissue resistance
Fasting - blood
Female
Fractures
Humans
Hyperglycemia - blood
Hyperglycemia - complications
Hyperglycemia - epidemiology
Injuries of the limb. Injuries of the spine
insulin
Insulin - blood
Male
Medical sciences
Medicine
Medicine & Public Health
Middle Aged
Original Article
Orthopedics
Osteoporosis. Osteomalacia. Paget disease
Osteoporotic Fractures - blood
Osteoporotic Fractures - complications
Osteoporotic Fractures - epidemiology
Pre-diabetes
Prediabetic State - complications
Prediabetic State - epidemiology
Rheumatology
Traumas. Diseases due to physical agents
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Summary:Summary The association between pre-diabetes and fracture risk remains unclear. In this large cohort of middle-aged and older Australian men and women without diabetes, elevated 2-h plasma glucose and pre-diabetes were associated with a reduced 5-year risk of low trauma and all fractures in women, independently of BMI, fasting insulin and other lifestyle factors. Introduction We aimed to (1) examine associations between fasting and 2-h plasma glucose (FPG and 2-h PG), fasting insulin and risk of low trauma and all fractures in non-diabetic adults and (2) compare fracture risk between adults with pre-diabetes (impaired glucose tolerance or impaired fasting glucose) and those with normal glucose tolerance (NGT). Methods Six thousand two hundred fifty-five non-diabetic men and women aged ≥40 years with NGT (n = 4,855) and pre-diabetes (n = 1,400) were followed for 5 years in the AusDiab Study. Fractures were self-reported. Results Five hundred thirty-nine participants suffered at least one fracture (368 women, 171 men), of which the majority (318) occurred after a low-energy trauma (258 women, 60 men). In women, a 2-h PG ≥7.2 mmol/L (highest quartile) was associated with a decreased risk of low trauma and all fractures independent of age and BMI [OR (95% CI) for low trauma fractures, 0.59 (0.40-0.88)], but also fasting insulin, smoking, physical activity, history of fracture, dietary calcium and alcohol intake or menopausal status. There was no effect of 2-h PG on fracture risk in men [OR (95% CI), 1.39 (0.60-3.26)] or any relationship between fracture risk and quartiles of FPG or insulin in either sex. Compared to women with NGT, those with pre-diabetes had a reduced risk of fracture [OR (95% CI) for all fractures, 0.70 (0.52-0.95); for low trauma fractures, 0.75 (0.53-1.05)]. Conclusion Elevated 2-h PG levels and pre-diabetes were inversely associated with low trauma and/or all fractures in non-diabetic women, independent of BMI and fasting insulin levels.
ISSN:0937-941X
1433-2965
DOI:10.1007/s00198-009-1164-y