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Obstructive Sleep Apnoea and Risk of Fragility Fracture in Patients With Type 2 Diabetes: A Population-Based
Esraa A Makhdom1,2,3, Anuradhaa Subramanian4, Krishnarajah Nirantharakumar4,5
1Department of Metabolism and Systems Science, University of Birmingham, Birmingham, UK.
Patients with type 2 diabetes and obstructive sleep apnoea (OSA) face a higher risk of fragility fractures. This increased fracture risk highlights the importance of considering bone health in T2D patients with OSA.
Area of Science:
- Endocrinology
- Sleep Medicine
- Orthopedics
Background:
- Type 2 diabetes (T2D) is linked to increased fracture risk.
- Obstructive sleep apnoea (OSA) is a common comorbidity in T2D.
- The combined impact of T2D and OSA on fragility fracture risk requires further investigation.
Purpose of the Study:
- To examine the association between obstructive sleep apnoea (OSA) and the risk of fragility fractures in patients with type 2 diabetes (T2D).
- To compare fracture risk in T2D patients with and without OSA.
Main Methods:
- Retrospective cohort study utilizing UK primary care data (2000-2022).
- Inclusion of T2D patients without prior fragility fractures.
- Matching of OSA patients with non-OSA controls based on age, sex, BMI, and T2D duration.
- Analysis of two cohorts: OSA diagnosed before T2D (cohort 1) and after T2D (cohort 2).
- Calculation of hazard ratios using Cox proportional hazards models.
Main Results:
- Cohort 1: 19,795 OSA patients vs. 64,124 non-OSA patients.
- Cohort 2: 21,769 OSA patients vs. 66,350 non-OSA patients.
- OSA was significantly associated with an increased risk of incident fragility fractures in both cohorts (aHR 1.12, p=0.04; aHR 1.15, p=0.002).
- Subgroup analyses indicated potential associations in men and individuals over 50 in cohort 1, and across genders and age groups in cohort 2.
Conclusions:
- Obstructive sleep apnoea (OSA) is associated with an elevated risk of fragility fractures in patients with type 2 diabetes (T2D).
- Further research is warranted to ascertain if OSA treatment mitigates this increased fracture risk.
- Clinicians should proactively assess bone health and fracture risk in T2D patients, especially older individuals.
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