{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T17:16:18Z","timestamp":1788369378760,"version":"build-2803163510"},"reference-count":31,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2016,9,24]],"date-time":"2016-09-24T00:00:00Z","timestamp":1474675200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,3,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2003<\/jats:title>\n                  <jats:p>Questions remain about whether the increased risk of fractures in patients with type 2 diabetes (T2DM) is related mainly to increased risk of falling or to bone-specific properties. The primary aim of this study was to investigate the risk of hip fractures and non-skeletal fall injuries in older men and women with and without T2DM. We included 429,313 individuals (aged 80.8\u2009\u00b1\u20098.2 years [mean\u2009\u00b1\u2009SD], 58% women) from the Swedish registry \u201cSenior Alert\u201d and linked the data to several nationwide registers. We identified 79,159 individuals with T2DM (45% with insulin [T2DM-I], 41% with oral antidiabetics [T2DM-O], and 14% with no antidiabetic treatment [T2DM-none]) and 343,603 individuals without diabetes. During a follow-up of approximately 670,000 person-years, we identified in total 36,132 fractures (15,572 hip fractures) and 20,019 non-skeletal fall injuries. In multivariable Cox regression models where the reference group was patients without diabetes and the outcome was hip fracture, T2DM-I was associated with increased risk (adjusted hazard ratio (HR) [95% CI] 1.24 [1.16\u20131.32]), T2DM-O with unaffected risk (1.03 [0.97\u20131.11]), and T2DM-none with reduced risk (0.88 [0.79\u20130.98]). Both the diagnosis of T2DM-I (1.22 [1.16\u20131.29]) and T2DM-O (1.12 [1.06\u20131.18]) but not T2DM-none (1.07 [0.98\u20131.16]) predicted non-skeletal fall injury. The same pattern was found regarding other fractures (any, upper arm, ankle, and major osteoporotic fracture) but not for wrist fracture. Subset analyses revealed that in men, the risk of hip fracture was only increased in those with T2DM-I, but in women, both the diagnosis of T2DM-O and T2DM-I were related to increased hip fracture risk. In conclusion, the risk of fractures differs substantially among patients with T2DM and an increased risk of hip fracture was primarily found in insulin-treated patients, whereas the risk of non-skeletal fall injury was consistently increased in T2DM with any diabetes medication. \u00a9 2016 American Society for Bone and Mineral Research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/jbmr.3002","type":"journal-article","created":{"date-parts":[[2016,9,24]],"date-time":"2016-09-24T22:37:22Z","timestamp":1474756642000},"page":"449-460","source":"Crossref","is-referenced-by-count":96,"title":["Type 2 Diabetes and Risk of Hip Fractures and Non-Skeletal Fall Injuries in the Elderly: A Study From the Fractures and Fall Injuries in the Elderly Cohort (FRAILCO)"],"prefix":"10.1093","volume":"32","author":[{"given":"M\u00e4rit","family":"Wallander","sequence":"first","affiliation":[{"name":"Geriatric MedicineCenter for Bone Research at the Sahlgrenska AcademyInstitute of MedicineUniversity of GothenburgGothenburgSweden"},{"name":"Department of Medicine HuddingeKarolinska InstituteStockholmSweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristian F","family":"Axelsson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic SurgerySkaraborg HospitalSk\u00f6vdeSweden"},{"name":"Geriatric MedicineCenter for Bone Research at the Sahlgrenska AcademyInstitute of MedicineUniversity of GothenburgGothenburgSweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anna G","family":"Nilsson","sequence":"additional","affiliation":[{"name":"Geriatric MedicineCenter for Bone Research at the Sahlgrenska AcademyInstitute of MedicineUniversity of GothenburgGothenburgSweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan","family":"Lundh","sequence":"additional","affiliation":[{"name":"School of BioscienceUniversity of Sk\u00f6vdeSk\u00f6vdeSweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mattias","family":"Lorentzon","sequence":"additional","affiliation":[{"name":"Geriatric MedicineCenter for Bone Research at the Sahlgrenska AcademyInstitute of MedicineUniversity of GothenburgGothenburgSweden"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2016,9,24]]},"reference":[{"key":"2024021014202284900_jbmr3002-bib-0001","year":"2002"},{"key":"2024021014202284900_jbmr3002-bib-0002","year":"2015"},{"key":"2024021014202284900_jbmr3002-bib-0003","year":"2007"},{"key":"2024021014202284900_jbmr3002-bib-0004","doi-asserted-by":"crossref","first-page":"1084","DOI":"10.1359\/JBMR.040311","article-title":"Diabetes is associated independently of body composition with BMD and bone volume in older white and black men and women: the Health, Aging, and Body Composition Study","volume":"19","author":"Strotmeyer","year":"2004","journal-title":"J Bone Miner Res"},{"key":"2024021014202284900_jbmr3002-bib-0005","doi-asserted-by":"crossref","first-page":"1192","DOI":"10.2337\/diacare.24.7.1192","article-title":"Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women","volume":"24","author":"Nicodemus","year":"2001","journal-title":"Diabetes Care"},{"key":"2024021014202284900_jbmr3002-bib-0006","doi-asserted-by":"crossref","first-page":"1292","DOI":"10.1007\/s00125-005-1786-3","article-title":"Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk","volume":"48","author":"Vestergaard","year":"2005","journal-title":"Diabetologia"},{"key":"2024021014202284900_jbmr3002-bib-0007","doi-asserted-by":"crossref","first-page":"1573","DOI":"10.2337\/dc06-0440","article-title":"Prospective study of diabetes and risk of hip fracture: the Nurses\u2019 Health Study","volume":"29","author":"Janghorbani","year":"2006","journal-title":"Diabetes Care"},{"key":"2024021014202284900_jbmr3002-bib-0008","doi-asserted-by":"crossref","first-page":"835","DOI":"10.2337\/dc06-1851","article-title":"The risk of hip fractures in older individuals with diabetes: a population-based study","volume":"30","author":"Lipscombe","year":"2007","journal-title":"Diabetes Care"},{"key":"2024021014202284900_jbmr3002-bib-0009","doi-asserted-by":"crossref","first-page":"3404","DOI":"10.1210\/jc.2006-0614","article-title":"Risk of fracture in women with type 2 diabetes: the Women's Health Initiative Observational Study","volume":"91","author":"Bonds","year":"2006","journal-title":"J Clin Endocrinol Metab"},{"key":"2024021014202284900_jbmr3002-bib-0010","doi-asserted-by":"crossref","first-page":"1054","DOI":"10.1002\/jbmr.2118","article-title":"Contemporary risk of hip fracture in type 1 and type 2 diabetes: a national registry study from Scotland","volume":"29","author":"Hothersall","year":"2014","journal-title":"J Bone Miner Res"},{"key":"2024021014202284900_jbmr3002-bib-0011","doi-asserted-by":"crossref","first-page":"1198","DOI":"10.2337\/diacare.24.7.1198","article-title":"Diabetes and risk of fracture: the Blue Mountains Eye Study","volume":"24","author":"Ivers","year":"2001","journal-title":"Diabetes Care"},{"key":"2024021014202284900_jbmr3002-bib-0012","doi-asserted-by":"crossref","first-page":"427","DOI":"10.1007\/s00198-006-0253-4","article-title":"Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes\u2014a meta-analysis","volume":"18","author":"Vestergaard","year":"2007","journal-title":"Osteoporos Int"},{"key":"2024021014202284900_jbmr3002-bib-0013","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1093\/aje\/kwm106","article-title":"Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture","volume":"166","author":"Janghorbani","year":"2007","journal-title":"Am J Epidemiol"},{"key":"2024021014202284900_jbmr3002-bib-0014","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1007\/s00198-015-3279-7","article-title":"Diabetes mellitus and risk of hip fractures: a meta-analysis","volume":"27","author":"Fan","year":"2016","journal-title":"Osteoporos Int"},{"key":"2024021014202284900_jbmr3002-bib-0015","doi-asserted-by":"crossref","first-page":"1726","DOI":"10.1007\/s00198-006-0172-4","article-title":"An estimate of the worldwide prevalence and disability associated with osteoporotic fractures","volume":"17","author":"Johnell","year":"2006","journal-title":"Osteoporos Int"},{"issue":"2","key":"2024021014202284900_jbmr3002-bib-0016","doi-asserted-by":"crossref","first-page":"159","DOI":"10.1016\/S2213-8587(15)00283-1","article-title":"Type 2 diabetes and the skeleton: new insights into sweet bones","volume":"4","author":"Shanbhogue","year":"2016","journal-title":"Lancet Diabetes Endocrinol"},{"key":"2024021014202284900_jbmr3002-bib-0017","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1016\/j.jdiacomp.2005.06.004","article-title":"Falls as a complication of diabetes mellitus in older people","volume":"20","author":"Tilling","year":"2006","journal-title":"J Diabetes Complications"},{"key":"2024021014202284900_jbmr3002-bib-0018","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1097\/QMH.0000000000000058","article-title":"Senior alert: a quality registry to support a standardized, structured, and systematic preventive care process for older adults","volume":"24","author":"Edvinsson","year":"2015","journal-title":"Qual Manag Health Care"},{"key":"2024021014202284900_jbmr3002-bib-0019","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/0021-9681(87)90171-8","article-title":"A new method of classifying prognostic comorbidity in longitudinal studies: development and validation","volume":"40","author":"Charlson","year":"1987","journal-title":"J Chronic Dis"},{"key":"2024021014202284900_jbmr3002-bib-0020","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1097\/01.ASW.0000439059.72199.41","article-title":"Predictive validity of 4 risk assessment scales for prediction of pressure ulcer development in a hospital setting","volume":"27","author":"Kallman","year":"2014","journal-title":"Adv Skin Wound Care"},{"key":"2024021014202284900_jbmr3002-bib-0021","doi-asserted-by":"crossref","first-page":"1749","DOI":"10.2337\/diacare.25.10.1749","article-title":"Older women with diabetes have a higher risk of falls: a prospective study","volume":"25","author":"Schwartz","year":"2002","journal-title":"Diabetes Care"},{"issue":"5","key":"2024021014202284900_jbmr3002-bib-0022","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/j.jdiacomp.2016.03.018","article-title":"Meta-analysis: association between hypoglycaemia and serious adverse events in older patients","volume":"30","author":"Mattishent","year":"2016","journal-title":"J Diabetes Complications"},{"key":"2024021014202284900_jbmr3002-bib-0023","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.2337\/dc12-1188","article-title":"High bone mineral density and fracture risk in type 2 diabetes as skeletal complications of inadequate glucose control: the Rotterdam Study","volume":"36","author":"Oei","year":"2013","journal-title":"Diabetes Care"},{"key":"2024021014202284900_jbmr3002-bib-0024","doi-asserted-by":"crossref","first-page":"1595","DOI":"10.1016\/j.bone.2007.02.021","article-title":"Biphasic fracture risk in diabetes: a population-based study","volume":"40","author":"Leslie","year":"2007","journal-title":"Bone"},{"key":"2024021014202284900_jbmr3002-bib-0025","author":"Kim"},{"key":"2024021014202284900_jbmr3002-bib-0026","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1159\/000362881","article-title":"Visual impairment and hip fractures: a case-control study in elderly patients","volume":"52","author":"Loriaut","year":"2014","journal-title":"Ophthalmic Res"},{"key":"2024021014202284900_jbmr3002-bib-0027","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1111\/j.1365-2265.2011.04222.x","article-title":"Diabetic peripheral neuropathy is highly associated with nontraumatic fractures in Korean patients with type 2 diabetes mellitus","volume":"77","author":"Kim","year":"2012","journal-title":"Clin Endocrinol"},{"key":"2024021014202284900_jbmr3002-bib-0028","doi-asserted-by":"crossref","first-page":"1983","DOI":"10.2337\/diacare.25.11.1983","article-title":"Incidence of falls, risk factors for falls, and fall-related fractures in individuals with diabetes and a prior foot ulcer","volume":"25","author":"Wallace","year":"2002","journal-title":"Diabetes Care"},{"key":"2024021014202284900_jbmr3002-bib-0029","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1001\/archinte.160.2.174","article-title":"Is diabetes associated with cognitive impairment and cognitive decline among older women? Study of Osteoporotic Fractures Research Group","volume":"160","author":"Gregg","year":"2000","journal-title":"Arch Intern Med"},{"key":"2024021014202284900_jbmr3002-bib-0030","doi-asserted-by":"crossref","first-page":"822","DOI":"10.1007\/s001980070040","article-title":"The injury mechanisms of osteoporotic upper extremity fractures among older adults: a controlled study of 287 consecutive patients and their 108 controls","volume":"11","author":"Palvanen","year":"2000","journal-title":"Osteoporos Int"},{"issue":"7","key":"2024021014202284900_jbmr3002-bib-0031","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2013-003222","article-title":"Accuracy of evidence-based criteria for identifying an incident hip fracture in the absence of the date of injury: a retrospective database study","volume":"3","author":"Vu","year":"2013","journal-title":"BMJ Open"}],"container-title":["Journal of Bone and Mineral Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjbmr.3002","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fjbmr.3002","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/32\/3\/449\/56652362\/jbmr3002.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jbmr\/article-pdf\/32\/3\/449\/56652362\/jbmr3002.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,3,13]],"date-time":"2024-03-13T14:57:48Z","timestamp":1710341868000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jbmr\/article\/32\/3\/449-460\/7605578"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,9,24]]},"references-count":31,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2016,9,24]]},"published-print":{"date-parts":[[2017,3,1]]}},"URL":"https:\/\/doi.org\/10.1002\/jbmr.3002","relation":{},"ISSN":["0884-0431","1523-4681"],"issn-type":[{"value":"0884-0431","type":"print"},{"value":"1523-4681","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2017,3,1]]},"published":{"date-parts":[[2016,9,24]]}}}