{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T20:52:17Z","timestamp":1792788737159,"version":"4.5.0"},"reference-count":35,"publisher":"American Diabetes Association","issue":"10","license":[{"start":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T00:00:00Z","timestamp":1785110400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.diabetesjournals.org\/journals\/pages\/license"}],"funder":[{"name":"Liv och H\u00e4lsa Society, Medical Society of Finland"},{"name":"Academy of Finland","award":["316664"],"award-info":[{"award-number":["316664"]}],"id":[{"id":"https:\/\/ror.org\/05k73zm37","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Novo Nordisk Foundation","award":["NNF23OC0082732"],"award-info":[{"award-number":["NNF23OC0082732"]}],"id":[{"id":"https:\/\/ror.org\/04txyc737","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Novo Nordisk Foundation","award":["NNFOC0013659"],"award-info":[{"award-number":["NNFOC0013659"]}],"id":[{"id":"https:\/\/ror.org\/04txyc737","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Wilhelm and Else Stockmann Foundation","id":[{"id":"https:\/\/ror.org\/02e6tmy71","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Folkh\u00e4lsan Research Foundation","id":[{"id":"https:\/\/ror.org\/01xjctg43","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Finnish Foundation for Cardiovascular Research","id":[{"id":"https:\/\/ror.org\/020apt798","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Finnish Diabetes Research Foundation","id":[{"id":"https:\/\/ror.org\/004j3q729","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Sigrid Jus\u00e9lius Foundation","award":["220027"],"award-info":[{"award-number":["220027"]}],"id":[{"id":"https:\/\/ror.org\/00ckakm23","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Sigrid Jus\u00e9lius Foundation","award":["250214"],"award-info":[{"award-number":["250214"]}],"id":[{"id":"https:\/\/ror.org\/00ckakm23","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Helsinki University Hospital","award":["TYH2023403"],"award-info":[{"award-number":["TYH2023403"]}],"id":[{"id":"https:\/\/ror.org\/02e8hzf44","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>To quantify the excess risk of any fractures, major osteoporotic fractures (MOF), and hip fractures in type 1 diabetes (T1D) by age, stages of diabetic kidney disease (DKD), and sex and to evaluate risk factors for fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                    <jats:p>The study included 5,035 individuals from the Finnish Diabetic Nephropathy Study (FinnDiane) and 12,286 control individuals without diabetes. We assessed the standardized incidence ratios (SIRs) for fractures in individuals with T1D compared with control individuals. Cox regression analyses were conducted in individuals with T1D to identify potential factors associated with fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>SIR for any fracture was 2.15 (95% CI 2.06\u20132.25), 2.60 (2.41\u20132.79) for MOF, and 5.24 (4.55\u20136.02) for hip fracture. SIR of hip fracture was the highest in those aged 40\u201349 years, 8.13 (5.75\u201311.2). All age-groups after 10\u201319 years had excess fracture risk. The SIR of any fracture increased with the DKD stages; 2.54 (2.36\u20132.72) in individuals without albuminuria, 3.47 (3.02\u20133.98) in those with moderate albuminuria, 3.73 (3.27\u20134.25) in those with severe albuminuria, and 5.08 (4.16\u20136.16) in those with kidney failure. SIRs for MOF were 2.62 (2.34\u20132.93) in those without albuminuria, 3.84 (3.10\u20134.71) in those with moderate albuminuria, 4.53 (3.72\u20135.48) in those with severe albuminuria, and 5.85 (4.38\u20137.68) in those with kidney failure. Hypoglycemic coma episodes (hazard ratio 1.04 [1.01\u20131.07]) and HbA1c (1.11 [1.06\u20131.15]) were associated with risk of any fracture, and episodes of diabetic ketoacidosis were associated with risk of MOF (1.18 [1.11\u20131.25]) in T1D.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Findings suggest that fracture risk assessment may need to be considered earlier than currently recommended, especially among individuals with DKD.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2337\/dc26-0612","type":"journal-article","created":{"date-parts":[[2026,7,27]],"date-time":"2026-07-27T17:25:41Z","timestamp":1785173141000},"page":"1803-1811","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":0,"title":["Fracture Risk Is Increased in Type 1 Diabetes and Is the Highest in Individuals With Diabetic Kidney Disease"],"prefix":"10.2337","volume":"49","author":[{"given":"Maija","family":"Feodoroff","sequence":"first","affiliation":[{"name":"Folkh\u00e4lsan Research Centre 1 , Helsinki, Finland"},{"name":"Department of Nephrology, University of Helsinki and Helsinki University Hospital 2 , Helsinki, Finland"},{"name":"Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki 3 , Helsinki, Finland"},{"name":"Department of Endocrinology and Diabetes, University of Helsinki and Helsinki University Hospital 4 , Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sari","family":"M\u00e4kimattila","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Research Centre 1 , Helsinki, Finland"},{"name":"Department of Nephrology, University of Helsinki and Helsinki University Hospital 2 , Helsinki, Finland"},{"name":"Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki 3 , Helsinki, Finland"},{"name":"Department of Endocrinology and Diabetes, University of Helsinki and Helsinki University Hospital 4 , Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lena M.","family":"Thorn","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Research Centre 1 , Helsinki, Finland"},{"name":"Department of Nephrology, University of Helsinki and Helsinki University Hospital 2 , Helsinki, Finland"},{"name":"Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki 3 , Helsinki, Finland"},{"name":"Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital 5 , Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per-Henrik","family":"Groop","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Research Centre 1 , Helsinki, Finland"},{"name":"Department of Nephrology, University of Helsinki and Helsinki University Hospital 2 , Helsinki, Finland"},{"name":"Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki 3 , Helsinki, Finland"},{"name":"Department of Diabetes, Central Clinical School, Monash University 6 , Melbourne, Victoria, Australia"},{"name":"Baker Heart and Diabetes Institute 7 , Melbourne, Victoria, Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4322-6942","authenticated-orcid":false,"given":"Niina","family":"Sandholm","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Research Centre 1 , Helsinki, Finland"},{"name":"Department of Nephrology, University of Helsinki and Helsinki University Hospital 2 , Helsinki, Finland"},{"name":"Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki 3 , Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3568-9779","authenticated-orcid":false,"given":"Valma","family":"Harjutsalo","sequence":"additional","affiliation":[{"name":"Folkh\u00e4lsan Research Centre 1 , Helsinki, Finland"},{"name":"Department of Nephrology, University of Helsinki and Helsinki University Hospital 2 , Helsinki, Finland"},{"name":"Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki 3 , Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"FinnDiane Study Group*","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1167","published-online":{"date-parts":[[2026,7,27]]},"reference":[{"key":"2026092114531033500_B1","first-page":"2987","article-title":"Improvements in the life expectancy of type 1 diabetes. 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