Fracture Risk Is Increased in Type 1 Diabetes and Is the Highest in Individuals With Diabetic Kidney Disease

OBJECTIVE To quantify the excess risk of any fractures, major osteoporotic fractures (MOF), and hip fractures in type 1 diabetes (T1D) by age, stages of diabetic kidney disease (DKD), and sex, and to evaluate risk factors for fractures. RESEARCH DESIGN AND METHODS The study included 5,035 individuals from the Finnish Diabetic Nephropathy Study (FinnDiane) and 12,286 control individuals without diabetes. We assessed the standardized incidence ratios (SIRs) for fractures in individuals with T1D compared with control individuals. Cox regression analyses were conducted in individuals with T1D to identify potential factors associated with fractures. RESULTS SIR for any fracture was 2.15 (95% CI 2.06–2.25), 2.60 (2.41–2.79) for MOF, and 5.24 (4.55–6.02) for hip fracture. SIR of hip fracture was the highest in those aged 40–49 years, 8.13 (5.75–11.2). All age-groups after 10–19 years had excess fracture risk. The SIR of any fracture increased with the DKD stages; 2.54 (2.36–2.72) in individuals without albuminuria, 3.47 (3.02–3.98), in those with moderate albuminuria, 3.73 (3.27–4.25) in those with severe albuminuria, and 5.08 (4.16–6.16) in those with kidney failure. SIRs for MOF were 2.62 (2.34–2.93) in those without albuminuria, 3.84 (3.10–4.71) in those with moderate albuminuria, 4.53 (3.72–5.48) in those with severe albuminuria, and 5.85 (4.38–7.68) in those with kidney failure. Hypoglycemic coma episodes (hazard ratio 1.04 [1.01–1.07]) and HbA1c (1.11 [1.06–1.15]) were associated with risk of any fracture, and episodes of diabetic ketoacidosis were associated with risk of MOF (1.18 [1.11–1.25]) in T1D. CONCLUSIONS Findings suggest that fracture risk assessment may need to be considered earlier than currently recommended, especially among individuals with DKD.