{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:50:13Z","timestamp":1790286613829,"version":"4.1.0"},"reference-count":37,"publisher":"Korean Diabetes Association","issue":"2","license":[{"start":{"date-parts":[[2023,1,19]],"date-time":"2023-01-19T00:00:00Z","timestamp":1674086400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100003725","name":"National Research Foundation of Korea","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100003725","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100014188","name":"Ministry of Science and ICT","doi-asserted-by":"crossref","award":["2021R1A2C2013890"],"award-info":[{"award-number":["2021R1A2C2013890"]}],"id":[{"id":"10.13039\/501100014188","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["e-dmj.org"],"crossmark-restriction":true},"short-container-title":["Diabetes Metab J"],"published-print":{"date-parts":[[2023,3,31]]},"abstract":"<jats:p>Background: Body mass index (BMI) is a risk factor for the type 2 diabetes (T2DM), and T2DM accompanies various complications, such as fractures. We investigated the effects of BMI and T2DM on fracture risk and analyzed whether the association varied with fracture locations.Methods: This study is a nationwide population-based cohort study that included all people with T2DM (n=2,746,078) who received the National Screening Program during 2009\u20132012. According to the anatomical location of the fracture, the incidence rate and hazard ratio (HR) were analyzed by dividing it into four categories: vertebra, hip, limbs, and total fracture.Results: The total fracture had higher HR in the underweight group (HR, 1.268; 95% CI, 1.228 to 1.309) and lower HR in the obese group (HR, 0.891; 95% CI, 0.882 to 0.901) and the morbidly obese group (HR, 0.873; 95% CI, 0.857 to 0.89), compared to reference (normal BMI group). Similar trends were observed for HR of vertebra fracture. The risk of hip fracture was most prominent, the risk of hip fracture increased in the underweight group (HR, 1.896; 95% CI, 1.178 to 2.021) and decreased in the obesity (HR, 0.643; 95% CI, 0.624 to 0.663) and morbidly obesity group (HR, 0.627; 95% CI, 0.591 to 0.665). Lastly, fracture risk was least affected by BMI for limbs.Conclusion: In T2DM patients, underweight tends to increase fracture risk, and overweight tends to lower fracture risk, but association between BMI and fracture risk varied depending on the affected bone lesions.<\/jats:p>","DOI":"10.4093\/dmj.2022.0001","type":"journal-article","created":{"date-parts":[[2023,2,2]],"date-time":"2023-02-02T06:28:01Z","timestamp":1675319281000},"page":"242-254","update-policy":"https:\/\/doi.org\/10.4093\/crossmark_policy","source":"Crossref","is-referenced-by-count":12,"title":["Association of Body Mass Index and Fracture Risk Varied by Affected Bones in Patients with Diabetes: A Nationwide Cohort Study"],"prefix":"10.4093","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8467-1957","authenticated-orcid":true,"given":"Se-Won","family":"Lee","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6096-1263","authenticated-orcid":true,"given":"Kyungdo","family":"Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4026-4572","authenticated-orcid":true,"given":"Hyuk-Sang","family":"Kwon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"2567","reference":[{"key":"ref1","first-page":"1513","volume-title":"Worldwide trends in diabetes since 1980: a pooled analysis of 751 population-based studies with 4.4 million participants","year":"2016"},{"key":"ref2","volume-title":"World Health Organization: Global report on diabetes: executive summary"},{"key":"ref3","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2017.03.024"},{"key":"ref4","doi-asserted-by":"publisher","DOI":"10.1016\/j.diabres.2018.01.013"},{"key":"ref5","doi-asserted-by":"publisher","DOI":"10.2337\/dc19-1807"},{"key":"ref6","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-005-1909-1"},{"key":"ref7","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-015-3279-7"},{"key":"ref8","first-page":"1198","volume-title":"Diabetes and risk of fracture: the Blue Mountains Eye Study","author":"Ivers","year":"2001"},{"key":"ref9","doi-asserted-by":"publisher","DOI":"10.1093\/gerona\/57.10.m648"},{"key":"ref10","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2020.115691"},{"key":"ref11","first-page":"1619","volume-title":"High bone mineral density and fracture risk in type 2 diabetes as skeletal complications of inadequate glucose control: the Rotterdam Study","author":"Oei","year":"2013"},{"key":"ref12","doi-asserted-by":"publisher","DOI":"10.3389\/fendo.2013.00062"},{"key":"ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-010-1357-4"},{"key":"ref14","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-011-1595-0"},{"key":"ref15","volume-title":"World Health Organization: Health topics: body mass index\u2013BMI"},{"key":"ref16","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.161.13.1581"},{"key":"ref17","doi-asserted-by":"publisher","DOI":"10.1001\/jama.289.1.76"},{"key":"ref18","doi-asserted-by":"publisher","DOI":"10.2337\/dc10-0067"},{"key":"ref19","first-page":"75","volume-title":"Increased risks of hip fracture in diabetic patients of Taiwan: a population-based study","author":"Chen","year":"2008"},{"key":"ref20","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-018-27147-0"},{"key":"ref21","doi-asserted-by":"publisher","DOI":"10.1016\/s0140-6736(03)15268-3"},{"key":"ref22","first-page":"i","volume-title":"Obesity: preventing and managing the global epidemic. Report of a WHO consultation","year":"2000"},{"key":"ref23","doi-asserted-by":"publisher","DOI":"10.30773\/pi.2020.0143"},{"key":"ref24","doi-asserted-by":"crossref","DOI":"10.1007\/0-387-29150-4","volume-title":"Survival analysis","author":"Kleinbaum","year":"2005"},{"key":"ref25","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-005-1863-y"},{"key":"ref26","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.2017"},{"key":"ref27","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-018-6230-y"},{"key":"ref28","doi-asserted-by":"publisher","DOI":"10.1111\/joim.12230"},{"key":"ref29","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-022-06398-8"},{"key":"ref30","doi-asserted-by":"publisher","DOI":"10.1016\/j.bone.2020.115457"},{"key":"ref31","doi-asserted-by":"publisher","DOI":"10.1186\/s40842-018-0060-9"},{"key":"ref32","doi-asserted-by":"publisher","DOI":"10.1359\/jbmr.041005"},{"key":"ref33","doi-asserted-by":"publisher","DOI":"10.1002\/jbmr.5650040320"},{"key":"ref34","first-page":"1749","volume-title":"Older women with diabetes have a higher risk of falls: a prospective study","author":"Schwartz","year":"2002"},{"key":"ref35","doi-asserted-by":"publisher","DOI":"10.1007\/s00198-017-4142-9"},{"key":"ref36","doi-asserted-by":"publisher","DOI":"10.1186\/s12933-019-0953-7"},{"key":"ref37","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2016.40.1.35"}],"container-title":["Diabetes &amp; Metabolism Journal"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/www.e-dmj.org\/upload\/pdf\/dmj-2022-0001.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.e-dmj.org\/journal\/view.php?doi=10.4093\/dmj.2022.0001","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/www.e-dmj.org\/upload\/pdf\/dmj-2022-0001.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,3,22]],"date-time":"2023-03-22T07:12:36Z","timestamp":1679469156000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.e-dmj.org\/journal\/view.php?doi=10.4093\/dmj.2022.0001"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,31]]},"references-count":37,"journal-issue":{"issue":"2","published-print":{"date-parts":[[2023,3]]}},"URL":"https:\/\/doi.org\/10.4093\/dmj.2022.0001","relation":{},"ISSN":["2233-6079","2233-6087"],"issn-type":[{"value":"2233-6079","type":"print"},{"value":"2233-6087","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,31]]},"assertion":[{"value":"2022-01-01","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-06-16","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-01-19","order":2,"name":"published","label":"Published online","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-31","order":3,"name":"published","label":"Print publication","group":{"name":"publication_history","label":"Publication History"}}]}}