Degree of Joint Risk Factor Control and Incident Fracture Outcomes in Individuals With Type 2 Diabetes

Individuals with type 2 diabetes have a higher fracture risk than the general population. However, the association between joint risk factor control and fracture risk in this population remains unclear.

To investigate the extent to which joint risk factor control might attenuate the excess risk of fracture outcomes in individuals with type 2 diabetes.

We included 8935 individuals with type 2 diabetes and 35 740 matched controls without fractures at baseline from the UK Biobank (UKB), with a median follow-up of 12.1 years. Six modifiable risk factors were assessed: body mass index (BMI), physical activity, smoking, alcohol consumption, serum 25-hydroxyvitamin D (25(OH)D), and glycated hemoglobin A1c (HbA1c). Cox proportional hazards models were used to estimate associations between risk factor control and fracture risk.

Controlling each additional risk factor resulted in a 14% to 26% decrease in fracture risk. Optimal control (≥5 risk factors) correlated with a 50% reduction in overall fractures (HR 0.50; 95% CI 0.33-0.75). However, a 60% reduction in hip fractures (HR 0.40; 95% CI 0.16-0.98) was observed with the control of 4 risk factors. With control of 4 or more risk factors, fracture risk in individuals with type 2 diabetes was comparable to that of nondiabetic controls, and the protective effect was stronger in men than in women.

Joint risk factor control was significantly linked to a reduced fracture risk, and optimal management may eliminate the excess fracture risk associated with type 2 diabetes.