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Cardiovascular Disease and Fracture Risk in People with Type 2 Diabetes: A Nationwide Matched Case-Control Study
Aksayan Arunanthy Mahalingasivam1,2, Annika Vestergaard Kvist3, Joop P van den Bergh4
1Steno Diabetes Centre North Denmark, Aalborg University Hospital, Aalborg, Denmark. aksayan.mahalingasivam@rn.dk.
Calcified Tissue International
|May 28, 2026
Summary
Cardiovascular disease (CVD) and certain medications increase fracture risk in type 2 diabetes (T2D) patients. This highlights the need to consider cardiovascular health when assessing fracture risk.
Area of Science:
- Endocrinology
- Cardiology
- Gerontology
- Orthopedics
Background:
- Type 2 diabetes (T2D) is linked to increased fracture risk.
- Cardiovascular disease (CVD) is a common comorbidity in T2D.
- The interplay between CVD, its treatments, and fracture risk in T2D requires further investigation.
Purpose of the Study:
- To investigate the association between CVD phenotypes, cardiovascular medications, and fracture risk in individuals with T2D.
- To examine any fracture as the primary outcome and major osteoporotic fracture (MOF) as a secondary outcome.
Main Methods:
- Nationwide registry-based matched case-control study in Denmark (2013-2021).
- 12,390 T2D patients with incident fractures (cases) matched 1:3 with 37,170 fracture-free T2D patients (controls).
- Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs).
Main Results:
- Overall CVD, clinical CVD, and subclinical CVD were associated with higher odds of any fracture.
- Specific CVD phenotypes (AFib/AFL, atherosclerosis, CKD, heart failure, hypercholesterolemia, hypertension, stroke) showed positive associations; AMI was inversely associated.
- Factor Xa inhibitors, nitrates, and antiplatelet agents were linked to higher fracture odds. Associations for MOF were weaker and non-significant.
Conclusions:
- CVD and selected cardiovascular medications are associated with an increased risk of fracture in individuals with T2D.
- These findings underscore the importance of integrating cardiovascular status into fracture risk assessments for T2D patients.
- No consistent sex-specific differences were observed in the associations between CVD phenotypes and fracture risk.
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