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This prospective cohort analysis used data from the UK Biobank, a large population-based cohort of participants recruited 2006-2010 at age 40-69\u00a0yr. The exposure was type 1 or type 2 diabetes at baseline, with the outcome of first incident osteoporotic fracture. Poisson regression was used to calculate incidence rate ratios (IRRs) for osteoporotic fracture to investigate prospective relationships between diabetes type 1 or 2 and fracture risk independent of traditional clinical risk factors, estimated BMD by heel ultrasound (eBMD), adiposity, and C-reactive protein (CRP). The role of diabetic microvascular complications and associations between diabetes duration and fracture risk were studied. There were 498\u2009949 participants (271\u2009882 women, mean age 56\u00a0yr; 227\u2009067 men, 57\u00a0yr). In fully adjusted models, type 1 and 2 diabetes were associated with increased fracture risk [type 1; IRR: 2.93 (95% CI: 2.37, 3.62); type 2: 1.25 (1.14, 1.38)], similar by sex. The magnitude of risk associated with type 2 diabetes increased with the duration of disease. Increasing number of microvascular complications was associated with greater fracture risk [any vs no complications, IRR 2.03 (1.57, 2.62)]. Diabetes is associated with increased risk of fracture (magnitude of effect greater in type 1 than type 2 diabetes). Associations were partly independent of traditional risk factors, adiposity, eBMD, and CRP. Type 2 diabetes disease duration and the presence of microvascular complications in both types were dose-dependent risk factors for fracture.<\/jats:p>","DOI":"10.1093\/jbmr\/zjaf094","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T12:37:37Z","timestamp":1752237457000},"page":"1246-1254","source":"Crossref","is-referenced-by-count":17,"title":["Type 1 and 2 diabetes mellitus: comprehensive fracture risk relationships in UK Biobank"],"prefix":"10.1093","volume":"40","author":[{"given":"Elizabeth M","family":"Curtis","sequence":"first","affiliation":[{"name":"MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital , Southampton SO16 6YD ,","place":["United Kingdom"]},{"name":"NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust , Southampton SO16 6YD,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2334-2284","authenticated-orcid":false,"given":"Rebecca J","family":"Moon","sequence":"additional","affiliation":[{"name":"MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital , Southampton SO16 6YD ,","place":["United Kingdom"]},{"name":"Department of Paediatric Endocrinology, University Hospital Southampton NHS Foundation Trust , Southampton SO16 6YD,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7267-1837","authenticated-orcid":false,"given":"Stefania","family":"D\u2019Angelo","sequence":"additional","affiliation":[{"name":"MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital , Southampton SO16 6YD ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Raisi-Estabragh","sequence":"additional","affiliation":[{"name":"Barts Heart Centre, St Bartholomew\u2019s Hospital, Barts Health NHS Trust , London EC1A 7BE,","place":["United Kingdom"]},{"name":"William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London , London EC1M 6BQ ,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3510-0709","authenticated-orcid":false,"given":"Cyrus","family":"Cooper","sequence":"additional","affiliation":[{"name":"MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital , Southampton SO16 6YD ,","place":["United Kingdom"]},{"name":"NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust , Southampton SO16 6YD,","place":["United Kingdom"]},{"name":"NIHR Oxford Biomedical Research Centre, University of Oxford , Oxford OX3 9DU,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8194-2512","authenticated-orcid":false,"given":"Nicholas C","family":"Harvey","sequence":"additional","affiliation":[{"name":"MRC Lifecourse Epidemiology Centre, University of Southampton, Southampton General Hospital , Southampton SO16 6YD ,","place":["United Kingdom"]},{"name":"NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital NHS Foundation Trust , Southampton SO16 6YD,","place":["United Kingdom"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"issue":"2","key":"2025103115321094600_ref1","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1038\/nrrheum.2009.260","article-title":"Osteoporosis: impact on health and 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