Associations of body mass index and diabetes with hip fracture risk: a nationwide cohort study - PubMed (original) (raw)

Associations of body mass index and diabetes with hip fracture risk: a nationwide cohort study

Hsiu-Ling Huang et al. BMC Public Health. 2018.

Abstract

Background: The high prevalence of diabetes is associated with body mass index (BMI), and diabetes can cause many complications, such as hip fractures. This study investigated the effects of BMI and diabetes on the risk of hip fractures and related factors.

Methods: We retrospectively reviewed data from 22,048 subjects aged ≧ 40 years from the National Health Interview Survey in Taiwan (NHIST) in 2001, 2005, and 2009. We linked the NHIST data for individual participants with the National Health Insurance Research Database (NHIRD), which includes the incidence of hip fracture from 2000 to 2013. We defined five categories for BMI: low BMI (BMI < 18.5), normal BMI (18.5 ≦ BMI < 24), overweight (24 ≦ BMI < 27), mild obesity (27 ≦ BMI < 30), and moderate obesity (BMI ≧ 30). The Cox proportional hazards model was used to analyze the effects of BMI and diabetes on risk of hip fracture.

Results: The Cox proportional hazards model shows that hip fracture risk in participants with diabetes was 1.64 times that of non-diabetes patients (95% confidence interval [CI]:1.30-2.15). Participants with low BMIs showed a higher hip fracture risk (HR: 1.75) than those with normal BMI. Among the five BMI groups, compared with non-diabetes patients, only diabetes patients with a normal BMI showed a significantly higher risk on hip fracture (HR: 2.13, 95% CI: 1.48-3.06). In participants with diabetes, compared with those with normal BMI, those with overweight or obesity showed significantly lower hip fracture risks (HR: 0.49 or 0.42). The hip fracture risk in participants who expend ≧ 500 kcal/week in exercise was 0.67 times lower than in those who did not exercise.

Conclusions: Diabetes and low BMI separately are important risk factors for hip fracture. There was an interaction between diabetes and BMI in the relationship with hip fracture (p = 0.001). The addition of energy expenditure through exercise could effectively decrease hip fracture risk, regardless of whether the participants have diabetes or not. The results of this study could be used as a reference for health promotion measures for people with diabetes.

Keywords: BMI; Body mass index; Diabetes; Hip fracture; National Health Insurance.

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Conflict of interest statement

Data are available from the Science Center, the Ministry of Health and Welfare (MOHW), Taiwan. This study obtained the databases published and managed by the MOHW. All researchers are allowed to use the databases for their interested studies. Before using the databases for research, all studies should get the IRB permission. The institutional review board of China Medical University approved this study (IRB No.: CMUH 103-REC3–109).

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Fig. 1

Comparisons of hip fracture risk among different BMI groups in patients with diabetes (After controlling for sex, age, urbanization of residence area, monthly salary, CCI, DCSI and weekly energy expenditure through exercise)

References

    1. Kannus P, Parkkari J, Sievänen H, Heinonen A, Vuori I, Järvinen M. Epidemiology of hip fractures. Bone. 1996;18(1):S57–S63. doi: 10.1016/8756-3282(95)00381-9. - DOI - PubMed
    1. Katsoulis M, Benetou V, Karapetyan T, Feskanich D, Grodstein F, Pettersson-Kymmer U, Eriksson S, Wilsgaard T, Jørgensen L, Ahmed L. Excess mortality after hip fracture in elderly persons from Europe and the USA: the CHANCES project. J Intern Med. 2017;281(3):300–310. doi: 10.1111/joim.12586. - DOI - PubMed
    1. Jürisson M, Pisarev H, Kanis J, Borgström F, Svedbom A, Kallikorm R, Lember M, Uusküla A. Quality of life, resource use, and costs related to hip fracture in Estonia. Osteoporos Int. 2016;27(8):2555–2566. doi: 10.1007/s00198-016-3544-4. - DOI - PubMed
    1. Dhaliwal R, Cibula D, Ghosh C, Weinstock R, Moses A. Bone quality assessment in type 2 diabetes mellitus. Osteoporos Int. 2014;25(7):1969–1973. doi: 10.1007/s00198-014-2704-7. - DOI - PubMed
    1. Janghorbani M, Van Dam RM, Willett WC, Hu FB. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166(5):495–505. doi: 10.1093/aje/kwm106. - DOI - PubMed

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