Weight change and the risk of hip fractures in patients with type 2 diabetes: a nationwide cohort study

Summary Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patien...

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Published in:	Osteoporosis international Vol. 33; no. 8; pp. 1755 - 1767
Main Authors:	Lee, S.-W., Han, K., Kwon, H.-S.
Format:	Journal Article
Language:	English
Published:	London Springer London 01.08.2022 Springer Nature B.V
Subjects:	Age Body weight Body weight gain Body weight loss Cohort analysis Diabetes Diabetes mellitus (non-insulin dependent) Endocrinology Exercise Fractures Hip Medicine Medicine & Public Health Morbidity Original Article Orthopedics Physical activity Physical fitness Physical training Population Rheumatology Sex differences Weight control Type 2 diabetes Hip fractures Weight change
ISSN:	0937-941X, 1433-2965, 1433-2965
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Abstract	Summary Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients. Introduction In type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. Materials and methods A total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%). Results Among 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise. Conclusions In the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most.
AbstractList	Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients.Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients.In type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population.INTRODUCTIONIn type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population.A total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%).MATERIALS AND METHODSA total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%).Among 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise.RESULTSAmong 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise.In the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most.CONCLUSIONSIn the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most. Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients. In type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. A total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%). Among 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise. In the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most. Summary Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients. Introduction In type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population. Materials and methods A total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%). Results Among 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise. Conclusions In the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most. SummaryBoth weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk of hip fracture. Regarding the risk of hip fracture, we can propose active monitoring to maintain the weight of type 2 diabetes patients.IntroductionIn type 2 diabetes, patients are often asked to control their weight in order to reduce their diabetic morbidity. The American Diabetes Association recommends that diabetic patients conduct high-intensity interventions for regulating diet, physical activity, and behavior to reduce weight, followed by long-term comprehensive weight maintenance programs. Although such weight control attempts are required in diabetic patients, there are few studies on the effect of weight change on hip fracture in this population. We aim to investigate the association between body weight change and the incidence of hip fracture in subjects with type 2 diabetes using large-scale, nationwide cohort data on the Korean population.Materials and methodsA total of 1,447,579 subjects (894,204 men and 553,375 women) > 40 years of age, who were diagnosed with type 2 diabetes, were enrolled in this study. Weight change within 2 years was divided into five categories: from weight loss ≥ 10% to weight gain ≥ 10%. The hazard ratios (HRs) and 95% confidence intervals for the incidence of hip fracture were analyzed, compared with the reference of the stable weight group (weight change < 5%).ResultsAmong 5 weight change groups, more than 10% weight loss showed the highest HR (HR, 1.605; 95% CI, 1.493 to 1.725), followed by more than 10% weight gain (HR, 1.457; 95% CI, 1.318 to 1.612). The effect of weight change on hip fracture risk was greater in males than in females, and those under 65 years of age were greater than those over 65 years of age. Baseline BMI did not play a role of weight change affecting the risk of hip fracture. The HR for hip fracture of subjects with regular exercise was lower than those without regular exercise.ConclusionsIn the type 2 diabetes population, both weight gain and weight loss were significantly associated with a higher risk of hip fracture, whereas maintaining body weight reduced the risk of hip fracture the most.
Author	Lee, S.-W. Han, K. Kwon, H.-S.
Author_xml	– sequence: 1 givenname: S.-W. surname: Lee fullname: Lee, S.-W. organization: Department of Orthopaedic Surgery, College of Medicine, The Catholic University of Korea, Department of Orthopaedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea – sequence: 2 givenname: K. surname: Han fullname: Han, K. email: hkd917@naver.com organization: Department of Statistics and Actuarial Science, Soongsil University – sequence: 3 givenname: H.-S. orcidid: 0000-0003-4026-4572 surname: Kwon fullname: Kwon, H.-S. email: drkwon@catholic.ac.kr organization: Division of Endocrinology and Metabolism, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Division of Endocrinology and Metabolism, Department of Internal Medicine, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea
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A prospective studyJama1989261266326681:STN:280:DyaL1M3hslWkug%3D%3D270954610.1001/jama.1989.03420180087036 VilacaTSchiniMHarnanSThe risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: a systematic review and meta-analysis updateBone20201371154573248002310.1016/j.bone.2020.115457 HothersallEJLivingstoneSJLookerHCContemporary risk of hip fracture in type 1 and type 2 diabetes: a national registry study from ScotlandJ Bone Miner Res201429105410602415512610.1002/jbmr.2118 Botella MartinezSVaro CenarruzabeitiaNEscalada San MartinJCallejaCAThe diabetic paradox: bone mineral density and fracture in type 2 diabetesEndocrinol Nutr2016634955012748144310.1016/j.endonu.2016.06.004 LangloisJAMussolinoMEVisserMLookerACHarrisTMadansJWeight loss from maximum body weight among middle-aged and older white women and the risk of hip fracture: the NHANES I epidemiologic follow-up studyOsteoporos Int2001127637681:STN:280:DC%2BD3MrlvFektw%3D%3D1160574310.1007/s001980170053 CawleyJMeyerhoeferCBienerAHammerMWintfeldNSavings in medical expenditures associated with reductions in body mass index among US adults with obesity, by diabetes statusPharmacoeconomics2015337077222538164710.1007/s40273-014-0230-2 ChunMYValidity and reliability of Korean version of International Physical Activity Questionnaire Short Form in the elderlyKorean J Fam Med20123314422787536339163910.4082/kjfm.2012.33.3.144 VestergaardPDiscrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysisOsteoporos Int2007184274441:STN:280:DC%2BD2s7jtVCltw%3D%3D1706865710.1007/s00198-006-0253-4 ShaoC-JHsiehY-HTsaiC-HLaiK-AA nationwide seven-year trend of hip fractures in the elderly population of TaiwanBone2009441251291884865610.1016/j.bone.2008.09.004 HannanMTFelsonDTDawson-HughesBRisk factors for longitudinal bone loss in elderly men and women: the Framingham Osteoporosis StudyJ Bone Miner Res2000157107201:STN:280:DC%2BD3c3ktFOktw%3D%3D1078086310.1359/jbmr.2000.15.4.710 CefaluWTBrayGAHomePDAdvances in the science, treatment, and prevention of the disease of obesity: reflections from aDiabetes CareEditors’ Expert ForumDiabetes Care201538156715821:CAS:528:DC%2BC2MXitVGnur3M26421334483190510.2337/dc15-1081 LeeSRChoiEKRheeTMEvaluation of the association between diabetic retinopathy and the incidence of atrial fibrillation: a nationwide population-based studyInt J Cardiol20162239539572758904310.1016/j.ijcard.2016.08.296 GrundySMCleemanJIDanielsSRDiagnosis and management of the metabolic syndromeCirculation2005112273527521615776510.1161/CIRCULATIONAHA.105.169404 Cheol Seong S, Kim Y-Y, Khang Y-H, et al. 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Clin Diabetes Endocrinol 4 LeeJHHanJHHanKDPsoriasis risk in patients with diabetic retinopathy: a nationwide population-based studySci Rep20188908629904118600252510.1038/s41598-018-27147-0 ItemFKonradDVisceral fat and metabolic inflammation: the portal theory revisitedObes Rev201213Suppl 230392310725710.1111/j.1467-789X.2012.01035.x De LiefdeIIVan Der KliftMDe LaetCEDHVan DaelePLAHofmanAPolsHAPBone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam StudyOsteoporos Int200516171317201594039 D Martinez-Laguna (6398_CR24) 2015; 26 TK Omsland (6398_CR11) 2009; 20 HY Park (6398_CR27) 2021; 142 HF Chen (6398_CR57) 2008; 31 N Pocock (6398_CR55) 1989; 4 KE Ensrud (6398_CR12) 1997; 157 X Li (6398_CR53) 2017; 28 B Curtis (6398_CR61) 2008; 1 SM Grundy (6398_CR36) 2005; 112 LA Ahmed (6398_CR26) 2006; 17 V Mpalaris (6398_CR31) 2015; 16 6398_CR40 6398_CR1 E Cereda (6398_CR51) 2011; 30 T Vilaca (6398_CR56) 2020; 137 AV Schwartz (6398_CR47) 2002; 25 EE Kershaw (6398_CR50) 2004; 89 6398_CR32 J Cawley (6398_CR4) 2015; 33 6398_CR33 D Dhanwal (6398_CR28) 2011; 45 KC Johnson (6398_CR43) 2017; 32 KL Margolis (6398_CR14) 2000; 133 C Conte (6398_CR17) 2018; 55 SO Song (6398_CR60) 2016; 40 AH Holmberg (6398_CR18) 2008; 93 JH Lee (6398_CR35) 2018; 8 II De Liefde (6398_CR25) 2005; 16 JW Nieves (6398_CR54) 2004; 20 JA Langlois (6398_CR9) 1998; 158 LJ Melton (6398_CR22) 2008; 23 MT Vogt (6398_CR15) 2002; 50 AR Chang (6398_CR5) 2019; 364 WHO Expert Consultation (6398_CR3) 2004; 363 C De Laet (6398_CR8) 2005; 16 C-J Shao (6398_CR29) 2009; 44 MY Chun (6398_CR38) 2012; 33 S Botella Martinez (6398_CR16) 2016; 63 P Vestergaard (6398_CR20) 2007; 18 CJ Crandall (6398_CR30) 2015; 350 DP Agarwal (6398_CR37) 2002; 37 WT Cefalu (6398_CR7) 2015; 38 KE Ensrud (6398_CR42) 2003; 51 6398_CR2 SR Lee (6398_CR34) 2016; 223 M Yoon (6398_CR39) 2021; 4 AS Levey (6398_CR41) 2003; 139 HE Meyer (6398_CR49) 1995; 311 AH Mokdad (6398_CR6) 2003; 289 C Chen (6398_CR19) 2020; 43 EW Lipkin (6398_CR45) 2014; 37 JA Langlois (6398_CR13) 1996; 156 6398_CR58 JA Langlois (6398_CR10) 2001; 12 B Dawson-Hughes (6398_CR48) 1997; 337 6398_CR59 EJ Hothersall (6398_CR23) 2014; 29 LL Lipscombe (6398_CR21) 2007; 30 MC Nevitt (6398_CR46) 1989; 261 MT Hannan (6398_CR44) 2000; 15 F Item (6398_CR52) 2012; 13
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Snippet	Summary Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered... Both weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the risk... SummaryBoth weight gain and weight loss in type 2 diabetic population were associated with increased risk of hip fracture, while maintaining weight lowered the...
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SubjectTerms	Age Body weight Body weight gain Body weight loss Cohort analysis Diabetes Diabetes mellitus (non-insulin dependent) Endocrinology Exercise Fractures Hip Medicine Medicine & Public Health Morbidity Original Article Orthopedics Physical activity Physical fitness Physical training Population Rheumatology Sex differences Weight control
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Title	Weight change and the risk of hip fractures in patients with type 2 diabetes: a nationwide cohort study
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