Summary: This retrospective study investigated the incidence of fracture in 4420 type 1 diabetes (T1DM) patients. Our findings indicate that patients with T1DM have an increased incidence of fractures. Further studies and preventive measures are urgently needed.
Introduction: The aim of this study was to investigate the incidence of fracture in patients with type 1 diabetes mellitus (T1DM).
Methods: This study is based on the German Disease Analyzer database and included 4258 adult individuals with a T1DM diagnosis documented between January 2000 and December 2015 in 1203 general practices in Germany. Individual matching of T1DM and non-diabetic patients was performed. The cumulative incidence of new fractures was shown for up to 10 years after the index date using Kaplan-Meier curves. Cox proportional hazard models (dependent variable: incident fracture) were used to estimate the effect of T1DM on fracture incidence, as well as the effect of predefined variables on fracture incidence.
Results: After 10 years of follow-up, the cumulative fracture incidence was 18.4% for T1DM patients and 9.9% for non-diabetic patients (p < 0.001). A strong association between T1DM and fractures was found (HR, 2.01 (95% CI, 1.70–2.38) p < 0.001) in both female and male patients. Significant differences between T1DM and non-diabetes patients were found in lower leg/ankle, foot and toe, shoulder/upper arm, and rib(s), sternum and thoracic spine fractures. A significant association between higher age and fracture incidence was observed in T1DM patients.
Conclusions: In summary, we found that patients with T1DM have a twofold increased fracture rate compared with healthy controls. Furthermore, fractures were associated with increased age and high HbA1c values.