Increased Risks of Hip Fracture in Diabetic Patients of Taiwan

Abstract

OBJECTIVE -Using Taiwan's National Health Insurance claim data, we evaluated the age-, sex-, and urbanization-specific incidence density and relative risks of hip fracture in the diabetic population.RESEARCH DESIGN AND METHODS -Diabetic patients (n ϭ 500,868) and an ageand sex-matched control group (n ϭ 500,248) were linked to inpatient claims (1997)(1998)(1999)(2000)(2001)(2002) to identify hospitalizations for nontransport accident hip fracture. The person-year approach with Poisson assumption and Kaplan-Meier analysis were used to estimate the incidence and the cumulative event rates. We also assessed the age-, sex-, and urbanization-specific relative risks of hip fracture in relation to diabetes with the Cox proportional hazard regression model. RESULTS-The overall incidences of hip fracture for diabetic men and women, respectively, were 3.01 and 6.75/1,000 person-years, which were higher than those for control men and women. There were significant interactions of diabetes and age and diabetes and urbanization statuses. Hazard ratios (HRs) of diabetic patients aged 35-44 years (men 2.45 [95% CI 1.65-3.64]; women 3.19 [1.39 -7.33]) were higher than those of diabetic patients aged 55-64 years (men 1.90; women 2.81), but in diabetic men aged Ͼ74 years and diabetic women aged Ͼ84 years, the HRs were compared with null statistically (HRs 0.98 and 0.91, respectively). Diabetic patients living in rural areas tended to have higher HRs of hip fracture.CONCLUSIONS -In Taiwan, diabetes increased the risk of hip fracture in both sexes in all age-groups except in diabetic men aged Ͼ74 years and diabetic women aged Ͼ84 years. Higher HRs of hip fracture were disproportionately observed in younger diabetic patients and in those living in rural areas. Diabetes Care 31:75-80, 2008T he incidence of hip fracture is expected to increase worldwide (1), and subsequent functional disability, morbidity, and mortality contribute tremendous health problems to our society. Diabetic patients, who have already been crippled by various microvascular and macrovascular complications, were reported to have increased risks of hip fracture (2-10). Much of the previous research, however, focused on women (4,5,8) or on older patients aged Ͼ65 years (4,9) so that relatively few data were available for specific risks in various agegroups and sex groups. Nearly all published studies were conducted in whites (10), and little information is available for Asian diabetic populations. Moreover, a recent study indicated that the relative risk of macrovascular disease associated with diabetes showed a significant geographic variation in Taiwan, implying a differential quality of care delivered to the diabetic patients in certain areas (11). No study so far has been conducted to investigate whether there is an urban-rural difference in incidence and relative risk of hip fracture in diabetic patients. In Taiwan, the high incidence (12) of hip fracture in the general population was reported previously, but the incidence of hip fracture among diabetic patient...

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