{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,29]],"date-time":"2026-04-29T09:53:21Z","timestamp":1777456401495,"version":"3.51.4"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T00:00:00Z","timestamp":1737763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Immune-mediated inflammatory diseases (IMIDs) are associated with chronic inflammation that may increase fracture risk; however, their impact within specific populations, such as those with type 2 diabetes mellitus (T2DM), remains unclear. This study aimed to evaluate the association between IMIDs and fracture risk, leveraging a large, high-quality population-based cohort of patients with T2DM. Methods: A total of 2,120,900 patients with T2DM without a previous history of fractures were enrolled from the nationwide health check-up database provided by the Korean National Health Insurance Service. The outcomes were overall, osteoporotic, non-osteoporotic, vertebral and hip fractures. Multivariable Cox proportional hazard regression analysis was performed to estimate the adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs) according to the presence of IMIDs. Results: The presence of ulcerative colitis (aHR: 1.31), rheumatoid arthritis (aHR: 1.19), ankylosing spondylitis (aHR: 1.32), and psoriasis (aHR: 1.14) were significantly associated with the risk of overall fractures. Compared with controls, patients with a single IMID (aHR: 1.18) and at least two IMIDs (aHR: 1.29) had a significantly increased risk of overall fractures, showing a dose\u2013response relationship. Similar results were observed for osteoporotic, vertebral, and hip fractures. Conclusions: The presence of IMIDs in patients with T2DM was associated with an increased risk of fractures, particularly osteoporotic, vertebral, and hip fractures. This study highlights the significant impact of IMIDs on fracture risk within a diabetic population, emphasizing the need for careful monitoring and tailored management strategies.<\/jats:p>","DOI":"10.3390\/jcm14030795","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T07:54:08Z","timestamp":1738050848000},"page":"795","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Association of Immune-Mediated Inflammatory Diseases and Fracture Risk in Patients with Type 2 Diabetes: A Nationwide Population-Based Study"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1574-9121","authenticated-orcid":false,"given":"Yuna","family":"Kim","sequence":"first","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7962-3697","authenticated-orcid":false,"given":"Oh Chan","family":"Kwon","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryul","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Neurology, Inha University Hospital, Incheon 22332, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jong Hoon","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Cutaneous Biology Research Institute, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6702-7692","authenticated-orcid":false,"given":"Min-Jae","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1189-7637","authenticated-orcid":false,"given":"Min-Chan","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Rheumatology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9198-3326","authenticated-orcid":false,"given":"Jie-Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Young Hoon","family":"Youn","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyojin","family":"Park","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Statistics and Actuarial Science, Soongsil University, Seoul 06978, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4212-0380","authenticated-orcid":false,"given":"Jaeyoung","family":"Chun","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul 06229, Republic of Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1375","DOI":"10.1016\/j.numecd.2021.01.019","article-title":"Bone fragility in patients with diabetes mellitus: A consensus statement from the working group of the Italian Diabetes Society (SID), Italian Society of Endocrinology (SIE), Italian Society of Gerontology and Geriatrics (SIGG), Italian Society of Orthopaedics and Traumatology (SIOT)","volume":"31","author":"Napoli","year":"2021","journal-title":"Nutr. 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