Incidence and risk factors for osteoporosis in people with type 2 diabetes mellitus in Thailand

Abstract

Background: Type 2 diabetes mellitus (T2DM) is documented to alter bone structure and increase fracture risk. This study aimed to determine the risk factors and incidence rate of osteoporosis in Thai adults with T2DM. Methods: A retrospective cohort study was conducted at Ramathibodi Hospital. People aged 18 or above who were diagnosed with T2DM between January 2010 and December 2019 and started diabetic medication were included. Participants with a history of osteoporosis were excluded. Osteoporosis was diagnosed by BMD T-score ≤ −2.5, ICD-10 for osteoporosis, ICD-9 for fragility fracture, or prescription of osteoporosis medication. The participants who did not meet the criteria were categorized as non-osteoporosis. Univariate and multivariate Cox regression analyses were used to determine risk factors for osteoporosis. Results: A total of 25,635 participants were recruited. During the study period, 790 participants were diagnosed with osteoporosis. The incidence rate was 58/10,000 person-year. Older age and female sex were associated with a greater risk of osteoporosis, with hazard ratios (HR) of 1.07 (1.06–1.08) and 4.41 (3.57–5.44), respectively. In contrast, higher BMI was associated with a reduction in osteoporosis [HR 0.95 (0.93–0.96)]. For Diabetes-related risk factors, dipeptidyl peptidase-4 inhibitors (DPP4-inhibitors), insulin, and thiazolidinediones were associated with a higher risk of osteoporosis; HR were 1.36 (1.05–1.75), 1.32 (1.05–1.65), and 1.39 (1.01–1.92), respectively. Dyslipidemia was also associated with osteoporosis [HR 1.36 (1.12–1.65)]. Conclusion: Older women with T2DM and dyslipidemia had a significantly higher risk of osteoporosis. Furthermore, insulin, thiazolidinediones, and DPP4 inhibitors are associated with increased fracture risk when compared to metformin.