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Cited by 272Bone health and osteoporosis researchDiabetes, Cardiovascular Risks, and LipoproteinsHIV-related health complications and treatments

Fracture risk in diabetic elderly men: the MrOS study

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Napoli, Nicola, Strotmeyer, Elsa S., Ensrud, Kristine E., Sellmeyer, Deborah E., Bauer, Douglas C., Hoffman, Andrew R., Dam, Thuy-Tien L., Barrett-Connor, Elizabeth +5 more·2014·Diabetologia
DOI 10.1007/s00125-014-3289-6PMC PMC4344350
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Abstract

Aims/hypothesis Diabetes mellitus is associated with increased fracture risk in women but few studies are available in men. To evaluate the relationship between diabetes and prospective non-vertebral fractures in elderly men, we used data from the Osteoporotic Fractures in Men (MrOS) study. Methods The MrOS enrolled 5,994 men (aged ≥65 years). Diabetes (ascertained by self-report, the use of medication for diabetes or an elevated fasting glucose level) was reported in 881 individuals, 80 of whom were using insulin. Hip and spine bone mineral density (BMD) was measured using dual x-ray absorptiometry (DXA). After recruitment, the men were followed for incident non-vertebral fractures using a triannual (3 yearly) questionnaire for an average of 9.1 (SD 2.7) years. The Cox proportional hazards model was used to assess the incident risk of fractures. Results In models adjusted for age, race, clinic site and total hip BMD, the risk of non-vertebral fracture was higher in men with diabetes compared with normoglycaemic men (HR 1.30, 95% CI 1.09, 1.54) and was elevated in men using insulin (HR 2.46, 95% CI 1.69, 3.59). Men with impaired fasting glucose did not have a higher risk of fracture compared with normoglycaemic men (HR 1.04, 95% CI 0.89, 1.21). After multivariable adjustment, the risk of non-vertebral fracture remained higher only among men with diabetes who were using insulin (HR 1.74, 95% CI 1.13, 2.69). Conclusions/interpretation Men with diabetes who are using insulin have an increased risk of non-vertebral fracture for a given age and BMD.

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  • Sulfonylureas and other insulin secretagogues such as meglitinides are associated with hypoglycemia, bone loss, and fracture risk.

    “Sulfonylureas and other insulin secretagogues such as the meglitinides (repaglinide and nateglinide) are associated with hypoglycemia, bone loss (115), and fracture risk (116) and should be used with caution.”

    From 13. Older Adults: Standards of Care in Diabetes—2025 (2025) · cites this paper as [116]

    The Results report an association between sulfonylurea use and increased fracture risk in older men with diabetes (HR 1.66; 95% CI 1.09–2.51). The cited paper does not report a fracture-risk finding for meglitinides; the separate bone-loss citation is not being judged here. No page numbers are available in our copy. (LLM, conf=0.88)

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  • Sulfonylureas are associated with hypoglycemia, bone loss, and fracture risk.

    “Sulfonylureas are associated with hypoglycemia, bone loss (121), and fracture risk (122)”

    From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [122]

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Authors
Napoli, N., Strotmeyer, E. S., Ensrud, K. E., Sellmeyer, D. E., Bauer, D. C., Hoffman, A. R., Dam, T.-T. L., Barrett-Connor, E., Palermo, L., Orwoll, E. S., Cummings, S. R., Black, D. M., & Schwartz, A. V.
Affiliations
  • Università Campus Bio-Medico (IT)
  • University of Pittsburgh (US)
  • University of Minnesota (US)
  • Johns Hopkins University (US)
  • University of California, San Francisco (US)
  • VA Palo Alto Health Care System (US)
  • University of California San Diego (US)
  • Oregon Health & Science University (US)
  • California Pacific Medical Center (US)
Corresponding author
Napoli, Nicola
ORCID
Venue
Diabetologia
Publisher
Springer Science and Business Media LLC
Published
2014-06-09
Volume
57
Issue
10
Pages
2057-2065
ISSN
  • 0012-186X (ISSN-L)
  • 1432-0428
DOI
10.1007/s00125-014-3289-6
PMC
PMC4344350
OpenAlex
W2032405190
Cited by
272
References
4
Citations by year
2026: 6 · 2025: 15 · 2024: 25 · 2023: 26 · 2022: 16 · 2021: 30 · 2020: 23 · 2019: 33 · 2018: 29 · 2017: 26 · 2016: 17 · 2015: 20 · 2014: 3 · 2013: 1 · 2012: 1
FWCI
22.90
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Diabetologia (publishedVersion)
  • PubMed (publishedVersion)
  • Europe PMC (PubMed Central) (acceptedVersion)
  • PubMed Central (acceptedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health (UL1TR000128)
  • National Institute on Aging (U01AG042145, U01-AG-18197, U01AG042143, U01AG018197, U01AG027810, U01AG042140)
  • National Institute of Arthritis and Musculoskeletal and Skin Diseases (U01AR45614, U01-AR45632, U01 AR45647, U01AR045583, U01 AR-45583, U01-AR-45654, U01AR045580, U01AR045632, U01AR045654, U01AR045614, U01AR045647, U01AR066160, U01AR45580)
  • National Center for Research Resources (UL1RR024140)
  • National Center for Advancing Translational Sciences
Topics
  • Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes, Cardiovascular Risks, and Lipoproteins
  • Health Sciences › Medicine › Emergency Medicine › HIV-related health complications and treatments
Keywords
diabetes mellitus, fracture risk, non-vertebral fractures, older men, insulin therapy, impaired fasting glucose, bone mineral density, hip fracture, osteoporosis, MrOS study
MeSH terms
Aged, Aged, 80 and over, Diabetes Mellitus, Humans, Insulin, Male, Prospective Studies, Risk Factors, Absorptiometry, Photon, Bone Density, Proportional Hazards Models, Fractures, Bone

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