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Participants were men and women 45 to 75 years old with type 2 diabetes and body mass index \u2265 25\u2005kg\/m2. Potential fracture predictors ascertained at randomization included traditional and diabetes-related risk factors (diabetes duration, diabetic neuropathy, antidiabetic medication use, hemoglobin A1c, and renal function). Total hip bone mineral density (BMD) was measured in a subcohort. Primary outcome was all incident clinical fractures, ascertained by self-report and centrally adjudicated with medical records review.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Over a median 12.2-year follow-up, 649 of the 4703 participants experienced at least one clinical fracture. Thiazolidinedione use (hazard ratio [HR] 1.22; 95% CI, 1.02-1.46) and insulin use (HR 1.34, 95% CI, 1.08-1.66) were significant diabetes-related predictors of all clinical fractures. When measured in a subcohort (n = 1285), total hip BMD was the strongest modifiable predictor of all clinical fractures (per 1 SD = 0.1\u2005g\/cm2 increase, HR 0.47; 95% CI, 0.39-0.58).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Thiazolidinedione and insulin use predict clinical fracture in middle-aged and older persons with type 2 diabetes and overweight or obesity. Evaluating BMD is advisable if these medications are prescribed. Fracture risk prediction tools may consider including thiazolidinedione and insulin use to refine prediction in this population.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1210\/clinem\/dgae623","type":"journal-article","created":{"date-parts":[[2024,9,11]],"date-time":"2024-09-11T22:40:01Z","timestamp":1726094401000},"page":"e1911-e1933","source":"Crossref","is-referenced-by-count":1,"title":["Predictors of Fracture in Middle-Aged and Older Adults With Type 2 Diabetes and Overweight or Obesity"],"prefix":"10.1210","volume":"110","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9927-6063","authenticated-orcid":false,"given":"Rachel E","family":"Elam","sequence":"first","affiliation":[{"name":"Division of Rheumatology, Department of Medicine, Medical College of Georgia, Augusta University , Augusta, GA 30912 ,","place":["USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karen C","family":"Johnson","sequence":"additional","affiliation":[{"name":"Department of 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