Unmasking fracture risk in type 2 diabetes: the association of longitudinal glycemic hemoglobin level and medications
Open accessAbstract
Context Fracture risk is underestimated in people with type 2 diabetes (T2D). Objective To investigate the longitudinal relationship of glycated hemoglobin (HbA1c) and common medications on fracture risk in people with T2D. Methods This retrospective population-based cohort study was conducted using de-identified claims and electronic health record data obtained from the OptumLabs Data Warehouse for the period January 1, 2007, to September 30, 2015. For each individual, the study was conducted within a 2-year HbA1c observation period and a 2-year fracture follow-up period. A cohort of 157 439 individuals with T2D [age ≥ 55 years with mean HbA1c value ≥ 6%] were selected from 4 018 250 US Medicare Advantage/Commercial enrollees with a T2D diagnosis. All fractures and fragility fractures were measured. Results With covariates adjusted, poor glycemic control in T2D individuals was associated with an 29% increase of all fracture risk, compared with T2D individuals who had adequate glycemic control (HR: 1.29; 95% CI, 1.22-1.36). Treatment with metformin (HR: 0.88; 95% CI, 0.85-0.92) and DPP4 inhibitors (HR: 0.93; 95% CI, 0.88-0.98) was associated with a reduced all fracture risk, while insulin (HR: 1.26; 95% CI, 1.21-1.32), thiazolidinediones (HR: 1.23; 95% CI, 1.18-1.29), and meglitinides (HR: 1.12; 95% CI, 1.00-1.26) were associated with an increased all fracture risk (All P value Conclusion Longitudinal 2-year HbA1c is independently associated with elevated all fracture risk in…
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Meglitinides (repaglinide and nateglinide) increase the risk of hypoglycemia and fracture risk.
“meglitinides (repaglinide and nateglinide) increase the risk of hypoglycemia and fracture risk”
From 13. Older Adults: Standards of Care in Diabetes—2026 (2026) · cites this paper as [124]
Cites
Influence of nonenzymatic glycation on biomechanical properties of cortical bone
Vashishth, D., Gibson, G. J., Khoury, J. I., Schaffler, M. B., Kimura, J., & Fyhrie, D. P. (2001) · Bone · doi:10.1016/s8756-3282(00)00434-8 · Cited by 525 · see citing works
Self-citationZhang, Y. S., Weng, W. Y., Xie, B. C., Meng, Y., Hao, Y. H., Liang, Y. M., & Zhou, Z. K. (2018) · Osteoporosis International · doi:10.1007/s00198-018-4649-8 · Cited by 93 · see citing works
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13. Older Adults: Standards of Care in Diabetes—2026
American Diabetes Association Professional Practice Committee for Diabetes*, Bajaj, M., McCoy, R. G., Balapattabi, K., Bannuru, R. R., Bellini, N. J., Bennett, A. K., Beverly, E. A., Briggs Early, K., ChallaSivaKanaka, S., et al. (2026) · Diabetes Care · doi:10.2337/dc26-s013 · Cited by 87 · see citing works
The effects of type 1 and type 2 diabetes mellitus on bone health in chronic kidney disease
Aleksova, J., Ebeling, P., & Elder, G. (2025) · Nature Reviews Endocrinology · doi:10.1038/s41574-024-01083-8 · Cited by 20 · see citing works
- Authors
- Wang, B., Wang, Z., Poundarik, A. A., Zaki, M. J., Bockman, R. S., Glicksberg, B. S., Nadkarni, G. N., & Vashishth, D.
- Affiliations
- Rensselaer Polytechnic Institute (US)
- Hospital for Special Surgery (US)
- Icahn School of Medicine at Mount Sinai (US)
- Corresponding author
- Vashishth, Deepak
- ORCID
- Venue
- The Journal of Clinical Endocrinology & Metabolism
- Publisher
- The Endocrine Society
- Published
- 2021-12-09
- Volume
- 107
- Issue
- 4
- Pages
- e1390-e1401
- ISSN
- 0021-972X (ISSN-L)
- 1945-7197
- PMC
- PMC8947783
- OpenAlex
- W4200004260
- Cited by
- 37
- References
- 2
- Citations by year
- 2026: 3 · 2025: 10 · 2024: 11 · 2023: 8 · 2022: 5
- FWCI
- 5.90
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
- Locations
- The Journal of Clinical Endocrinology & Metabolism (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institutes of Health
- National Institute of Arthritis and Musculoskeletal and Skin Diseases (R21 AR071681)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Treatment and Management
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Research
- Keywords
- type 2 diabetes, fracture risk, HbA1c, glycemic control, metformin, DPP-4 inhibitors, insulin, thiazolidinediones, meglitinides, bisphosphonates, fragility fractures, osteoporosis, antidiabetic drugs, older adults, Medicare beneficiaries, fracture risk prediction model, HbA1c thresholds
- MeSH terms
- Aged, Blood Glucose, Diabetes Mellitus, Type 2, Medicare, Glycated Hemoglobin, Hemoglobins, Humans, Hypoglycemic Agents, Metformin, Middle Aged, Retrospective Studies, United States, Cohort Studies, Fractures, Bone, Dipeptidyl-Peptidase IV Inhibitors
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