{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T08:55:15Z","timestamp":1777020915342,"version":"3.51.4"},"reference-count":32,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,7,22]],"date-time":"2015-07-22T00:00:00Z","timestamp":1437523200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"name":"John A. Hartford Foundation\/AFAR"},{"name":"Duke Claude A. Pepper Center"},{"DOI":"10.13039\/100000049","name":"National Institute on Aging","doi-asserted-by":"crossref","award":["2P30AG028716-08"],"award-info":[{"award-number":["2P30AG028716-08"]}],"id":[{"id":"10.13039\/100000049","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2015,8]]},"abstract":"\n Objectives<\/jats:title>\n \n To examine the effect of functional impairments in older women with diabetes mellitus (\n DM<\/jats:styled-content>\n ) on incident clinical fractures.\n <\/jats:p>\n <\/jats:sec>\n \n Design<\/jats:title>\n Secondary analysis of two large prospective cohort studies.<\/jats:p>\n <\/jats:sec>\n \n Setting<\/jats:title>\n \n North Carolina Established Populations for Epidemiologic Studies of the Elderly (\n EPESE<\/jats:styled-content>\n ) and Women's Health Initiative (\n WHI<\/jats:styled-content>\n ) clinical trials.\n <\/jats:p>\n <\/jats:sec>\n \n Participants<\/jats:title>\n \n EPESE<\/jats:styled-content>\n included 2,704 community\u2010dwelling women aged 65 and older;\n WHI<\/jats:styled-content>\n clinical trials included 68,125 postmenopausal women.\n <\/jats:p>\n <\/jats:sec>\n \n Measurements<\/jats:title>\n \n Women with\n DM<\/jats:styled-content>\n at baseline were compared with women without in successive Cox proportional hazards models. Functional limitations were determined according to self\u2010reported difficulties with activities of daily living (\n ADL<\/jats:styled-content>\n s) and physical activities.\n <\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The risk of any clinical fracture during the study period was greater in women with\n DM<\/jats:styled-content>\n , after controlling for age, race and ethnicity, and body mass index, in the\n EPESE<\/jats:styled-content>\n (hazard ratio (\n HR<\/jats:styled-content>\n )\u00a0=\u00a01.36, 95% confidence interval (\n CI<\/jats:styled-content>\n )\u00a0=\u00a01.08\u20131.72) and\n WHI<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n \u00a0=\u00a01.29, 95%\n CI<\/jats:styled-content>\n \u00a0=\u00a01.19\u20131.39) cohorts. After inclusion of functional limitations, the greater risk of fracture associated with\n DM<\/jats:styled-content>\n decreased in the\n EPESE<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n \u00a0=\u00a01.25, 95%\n CI<\/jats:styled-content>\n \u00a0=\u00a00.98\u20131.59) and\n WHI<\/jats:styled-content>\n (\n HR<\/jats:styled-content>\n \u00a0=\u00a01.21, 95%\n CI<\/jats:styled-content>\n \u00a0=\u00a01.12\u20131.31) cohorts. In participants with\n DM<\/jats:styled-content>\n , difficulties with moderate physical activities, such as bending or stooping, walking several blocks, and heavy housework, were significantly associated with incident fracture (\n P<\/jats:italic>\n \u00a0<\u00a0.05).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n \n Older women with\n DM<\/jats:styled-content>\n are at greater risk of clinical fractures than those without, independent of bone mineral density. Greater functional impairment in moderate physical activities mediates this greater fracture risk in part, although there remains an unexplained residual\n DM<\/jats:styled-content>\n \u2013associated risk for fracture.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/jgs.13556","type":"journal-article","created":{"date-parts":[[2015,7,22]],"date-time":"2015-07-22T07:23:11Z","timestamp":1437549791000},"page":"1546-1551","source":"Crossref","is-referenced-by-count":13,"title":["Functional Impairments Mediate Association Between Clinical Fracture Risk and Type 2 Diabetes Mellitus in Older Women"],"prefix":"10.1111","volume":"63","author":[{"given":"Richard H.","family":"Lee","sequence":"first","affiliation":[{"name":"Division of Endocrinology, Metabolism, and Nutrition Department of Medicine Duke University Medical Center School of Medicine Durham North Carolina"},{"name":"Center for the Study of Aging and Human Development School of Medicine Durham North Carolina"},{"name":"Geriatric Research Education and Clinical Center Durham Veterans Affairs Medical Center Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carl F.","family":"Pieper","sequence":"additional","affiliation":[{"name":"Center for the Study of Aging and Human Development School of Medicine Durham North Carolina"},{"name":"Department of Biostatistics and Bioinformatics Duke University Medical Center School of Medicine Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cathleen","family":"Col\u00f3n\u2010Emeric","sequence":"additional","affiliation":[{"name":"Center for the Study of Aging and Human Development School of Medicine Durham North Carolina"},{"name":"Geriatric Research Education and Clinical Center Durham Veterans Affairs Medical Center Durham North Carolina"},{"name":"Division of Geriatrics Department of Medicine Duke University Medical Center Durham North Carolina"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2015,7,22]]},"reference":[{"key":"e_1_2_6_2_1","unstructured":"Diabetes Data & Trends.Centers for Disease Control and Prevention [on\u2010line]. 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