{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,24]],"date-time":"2026-08-24T15:18:13Z","timestamp":1787584693230,"version":"build-2736575974"},"reference-count":39,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":1,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,2,1]],"date-time":"2026-02-01T00:00:00Z","timestamp":1769904000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J cachexia sarcopenia muscle"],"published-print":{"date-parts":[[2026,2]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Type 2 diabetes is associated with an increased risk of fragility fractures. While obesity may protect against fractures, individuals with type 2 diabetes often exhibit other metabolic syndrome (MetS) traits and albuminuria. We evaluated their roles and synergistic implications on incident fractures, stratified by obesity status.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients with type 2 diabetes were identified from territory\u2010wide electronic health records in Hong Kong (2000\u20132018). MetS\u2010related traits included albuminuria and individual MetS traits (obesity, hypertension, low HDL\u2010cholesterol and hypertriglyceridemia). Outcomes were hip and major osteoporotic fractures (MOF). Patients were followed until fracture, death or 31 December 2020. Adjusted hazard ratios (aHRs) were estimated using multivariable Cox models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among 165\u2009289 patients with type 2 diabetes (median age: 60.0\u2009years; 54.2% men), 1583 (0.96%) experienced hip fractures, and 3393 (2.05%) had MOF over a median follow\u2010up of 5.3\u2009years. Albuminuria was the strongest risk factor for hip fractures (obese: aHR 1.33, 95% CI 1.11\u20131.60; non\u2010obese: 1.54, 1.33\u20131.78) and MOF (obese: 1.13, 1.01\u20131.26; non\u2010obese: 1.28, 1.15\u20131.43). Hypertension was a significant risk factor only in non\u2010obese patients. In the non\u2010obese group, each additional MetS\u2010related trait was associated with an increased risk of hip fracture and MOF. When stratified by diabetes duration, albuminuria remained a significant risk factor across different diabetes durations, while suboptimal glycaemic control became a significant risk factor particularly when diabetes duration \u2265\u20095\u2009years.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this large population\u2010based cohort of patients with type 2 diabetes predominantly of Asian descent from Hong Kong, albuminuria emerged as an important predictor of fracture risk. MetS traits compound this risk, especially in non\u2010obese individuals. These findings could be instrumental in shaping screening initiatives for fracture risk optimization in type 2 diabetes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jcsm.70215","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T05:56:26Z","timestamp":1770098186000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Associations of Albuminuria and Metabolic Syndrome Traits With Fracture Risk in Patients With Type 2 Diabetes: A Population\u2010Based Cohort Study"],"prefix":"10.1002","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9418-7448","authenticated-orcid":false,"given":"Xi","family":"Xiong","sequence":"first","affiliation":[{"name":"Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine The University of Hong Kong  Hong Kong SAR China"},{"name":"Laboratory of Data Discovery for Health (D<sup>2<\/sup>4H) Hong Kong Science and Technology Park  Hong Kong SAR China"},{"name":"Research Department of Practice and Policy, School of Pharmacy University College London  London UK"},{"name":"Department of Non\u2010Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health London School of Hygiene and Tropical Medicine  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9813-1126","authenticated-orcid":false,"given":"David\u00a0T.\u00a0W.","family":"Lui","sequence":"additional","affiliation":[{"name":"Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Hong Kong SAR China"},{"name":"Asia Pacific Consortium on Osteoporosis (APCO)  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7860-6262","authenticated-orcid":false,"given":"Chengsheng","family":"Ju","sequence":"additional","affiliation":[{"name":"Research Department of Practice and Policy, School of Pharmacy University College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2592-8310","authenticated-orcid":false,"given":"Xiaodong","family":"Liu","sequence":"additional","affiliation":[{"name":"Laboratory of Data Discovery for Health (D<sup>2<\/sup>4H) Hong Kong Science and Technology Park  Hong Kong SAR China"},{"name":"Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine The University of Hong Kong  Hong Kong SAR China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8840-7267","authenticated-orcid":false,"given":"Li","family":"Wei","sequence":"additional","affiliation":[{"name":"Laboratory of Data Discovery for Health (D<sup>2<\/sup>4H) Hong Kong Science and Technology Park  Hong Kong SAR China"},{"name":"Research Department of Practice and Policy, School of Pharmacy University College London  London UK"},{"name":"Centre for Medicines Optimization Research and Education University College London Hospitals NHS Foundation Trust  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manju","family":"Chandran","sequence":"additional","affiliation":[{"name":"Asia Pacific Consortium on Osteoporosis (APCO)  Hong Kong SAR China"},{"name":"Osteoporosis and Bone Metabolism Unit, Department of Endocrinology Singapore General Hospital  Singapore Singapore"},{"name":"DUKE NUS Medical School  Singapore Singapore"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6895-6071","authenticated-orcid":false,"given":"Carlos\u00a0K.\u00a0H.","family":"Wong","sequence":"additional","affiliation":[{"name":"Laboratory of Data Discovery for Health (D<sup>2<\/sup>4H) Hong Kong Science and Technology Park  Hong Kong SAR China"},{"name":"School of Public Health, Li Ka Shing Faculty of Medicine The University of Hong Kong  Hong Kong SAR China"},{"name":"Department of Infectious Disease Epidemiology &amp; 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