Does diabetes increase the risk for fractures after solid organ transplantation? A nested case-control study

Area of Science:

• Transplantation Medicine
• Endocrinology
• Bone Health

Background:

• Diabetes mellitus is a known risk factor for osteoporosis in the general population.
• Both diabetes and fractures are common complications in solid organ transplant recipients.
• The specific impact of pretransplant diabetes on post-transplant fracture risk remains unclear.

Purpose of the Study:

• To evaluate the association between pretransplant diabetes and the incidence of fractures following solid organ transplantation.
• To determine if pretransplant diabetes is an independent risk factor for post-transplant fractures.

Main Methods:

• A nested case-control study was conducted using a cohort from the Quebec Drug Insurance Plan (1986-2005).
• Cases were patients who sustained a fracture post-transplant; controls were matched by organ type and transplant date.
• Conditional logistic regression models were used to calculate crude and adjusted odds ratios (ORs).

Main Results:

• The study included 238 cases and 873 controls.
• Pretransplant diabetes was present in 30% of cases vs. 22% of controls (crude OR: 2.16).
• Adjusted analysis confirmed pretransplant diabetes as a significant risk factor (adjusted OR: 1.94), alongside narcotics, antidepressants, and loop diuretic use.

Conclusions:

• Pretransplant diabetes is a significant risk factor for fractures occurring after solid organ transplantation in adults.
• Consideration of pretransplant fracture prophylaxis is warranted for diabetic patients undergoing solid organ transplantation.