Elevated fracture risk in a Danish cohort with type 2 diabetes mellitus and microvascular diseases

INTRODUCTION: Microvascular diseases (MVD) in type 2 diabetes mellitus (T2D) are associated with alterations in the bone microarchitecture, but their association with fracture risk is unclear. We investigated whether MVD (retinopathy, nephropathy, and neuropathy) are associated with higher fracture risk in persons with T2D. MATERIALS AND METHODS: We identified 10 491 persons with T2D, enrolled in the Danish Centre for Strategic Research in Type 2 Diabetes cohort between 2010 and 2022. The primary outcomes were any hospital-diagnosed fracture (except facial and cranial), and major osteoporotic fractures (MOF), defined as clinical vertebral, hip, humerus, and forearm fractures, in persons with hospital-diagnosed MVD vs without MVD. We used Cox proportional hazard models to calculate crude and adjusted hazard ratios (aHRs). RESULTS: During a median follow-up of 7.6 yr IQR (3.5; 9.7), the rates of any fracture were higher in persons with T2D and MVD vs no MVD (aHR 1.31; 95% CI [1.15; 1.51]). Similarly, MOF rate was elevated in persons with MVD (aHR 1.33 [1.09; 161]). The rates for any fracture and MOF were highest in persons with neuropathy (aHR 1.49 [1.24; 1.78] and aHR 1.54 [1.19; 1.99], respectively). DISCUSSION: Fracture risk is elevated in persons with T2D complicated by MVD, particularly in those with neuropathy.