{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:43:42Z","timestamp":1790009022112,"version":"4.0.1"},"reference-count":34,"publisher":"Oxford University Press (OUP)","issue":"8","license":[{"start":{"date-parts":[[2018,4,6]],"date-time":"2018-04-06T00:00:00Z","timestamp":1522972800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"},{"start":{"date-parts":[[2018,5,3]],"date-time":"2018-05-03T00:00:00Z","timestamp":1525305600000},"content-version":"vor","delay-in-days":27,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["asbmr.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,8,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>\u2003<\/jats:title>\n                  <jats:p>Type 2 diabetes (T2DM) is associated with a reduced life expectancy. The latest published evidence suggests an increased risk of fractures among T2DM patients. We conducted a population-based cohort study to determine the impact of mortality as a competing risk in the study of the association between T2DM and hip fracture rates. Participants were all diagnosed T2DM patients registered in the Sistema de Informaci\u00f3n para el Desarrollo de la Investigaci\u00f3n en Atenci\u00f3n Primaria (SIDIAP) database aged 65 years and older; up to two non-T2DM were matched by age, sex, and primary care facility. We used Cox regression models to estimate cause-specific hazard ratio (HR) of death or hip fracture according to T2DM status. Fine and Gray models were then fitted to estimate the subhazard ratio (SHR) of hip fracture while accounting for competing risk with death and to estimate the probability of hip fracture within 5 years. A total of 55,891 T2DM and 103,093 matched non-T2DM patients were observed for a median of 8 years. Mortality was 48.8 per 1000 person years (py) in T2DM, and 33.8 per 1000 py in non-T2DM; hip fracture rates were 6.0 per 1000 py and 4.9 per 1000 py, respectively. Cox models confirmed a significant association for death and hip fracture: HR 1.51 (95% CI, 1.48 to 1.55), and HR 1.32 (95% CI, 1.24 to 1.40), respectively. Accounting for death as a competing event (Fine-Gray models), the association between T2DM and hip fracture risk remained statistically significant (SHR 1.15; 95% CI, 1.09 to 1.21) and the probability of a hip fracture within 5 years was 2.3% for TD2M and 1.9% for non-TD2M patients compared to 2.6% and 2.1% respectively using Kaplan-Meier (KM) estimates. T2DM patients have a 50% increased mortality and, after adjusting for differential survival at 5 years, a 21% increased incidence of hip fracture when compared to matched non-T2DM. Failing to account for differential mortality leads to an overestimation of fracture risk. \u00a9 2018 American Society for Bone and Mineral Research.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/jbmr.3435","type":"journal-article","created":{"date-parts":[[2018,4,6]],"date-time":"2018-04-06T22:32:15Z","timestamp":1523053935000},"page":"1417-1421","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":32,"title":["Differential Mortality and the Excess Rates of Hip Fracture Associated With Type 2 Diabetes: Accounting for Competing Risks in Fracture Prediction Matters"],"prefix":"10.1093","volume":"33","author":[{"given":"Cristian","family":"Teb\u00e9","sequence":"first","affiliation":[{"name":"Department of Basic Medical SciencesUniversitat Rovira i VirgiliReusSpain"},{"name":"Department of Basic Medical SciencesUniversitat de BarcelonaBarcelonaSpain"},{"name":"Biostatisitcs Unit at Bellvitge Biomedical Research Institute (IDIBELL)L'Hospitalet de LlobregatSpain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Martinez-Laguna","sequence":"additional","affiliation":[{"name":"Ambit BarcelonaPrimary Care DepartmentInstitut Catala de la SalutBarcelonaSpain"},{"name":"Grup de Recerca en Malalties Prevalents de l'Aparell Locomotor (GREMPAL) Research Group and CIBERFesUniversity Institute for Primary Care Research (IDIAP) Jordi GolUniversitat Autonoma de Barcelona and Instituto de Salud Carlos IIIBarcelonaSpain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Victor","family":"Moreno","sequence":"additional","affiliation":[{"name":"Consortium for Biomedical Research in Epidemiology & Public Health, CIBERESPMadridSpain"},{"name":"Unit of Biomarkers and Susceptibility, Cancer Prevention and Control Program, Catalan Institute of Oncology (ICO), IDIBELLL'Hospitalet de LlobregatSpain"},{"name":"Department of Basic Medical SciencesUniversitat de BarcelonaBarcelonaSpain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cyrus","family":"Cooper","sequence":"additional","affiliation":[{"name":"Medical Research Council (MRC) Lifecourse Epidemiology UnitUniversity of SouthamptonUK"},{"name":"Oxford NIHR Biomedical Research CentreUniversity of OxfordOxfordUK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adolfo","family":"Diez-Perez","sequence":"additional","affiliation":[{"name":"Musculoskeletal Research UnitIMIM-Hospital del Mar and CIBERFesUniversitat Aut\u00f2noma de Barcelona and Instituto de Salud Carlos IIIBarcelonaSpain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gary S","family":"Collins","sequence":"additional","affiliation":[{"name":"Centre for Statistics in Medicine (CSM)Nuffield Department of OrthopaedicsRheumatology, and Musculoskeletal Sciences (NDORMS)University of OxfordOxfordUK"},{"name":"Medical Research Council (MRC) Lifecourse Epidemiology UnitUniversity of 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