The risk of hip fracture has increased in diabetic patients in Taiwan, according to a study published in the January issue of Diabetes Care. The risk of hip fracture has increased in diabetic patients in Taiwan, according to a study published in the January issue of Diabetes Care.

"Diabetic patients, who have already been crippled by various microvascular and macrovascular complications, were reported to have increased risks of hip fracture," Dr. Chung-Yi Li, of National Taipei College of Nursing, Taiwan, and colleagues write. "Much of the previous research, however, focused on women or on older patients aged older than 65 years so that relatively few data were available for specific risks in various age groups and sex groups."

The researchers used Taiwan's National Health Insurance claim data to examine age-, sex-, and urban area-specific effects of diabetes on the incidence and relative risks of hip fracture between 1997 and 2002 in the diabetic population. A total of 500,868 diabetic patients and 500,248 age- and sex-matched control subjects were linked to inpatient claims to identify hospitalizations for nontransport accident hip fracture.

The overall incidences of hip fracture for men and women with diabetes were 3.01 and 6.75 per 1000 person-years, respectively. These were higher than those for control men and women, which were 2.48 and 4.21 per 1000 person-years, respectively. Significant interactions were observed between diabetes and age and diabetes and urbanization status.

The team reports that the highest sex- and age-specific hazard ratio (HR) of hip fracture was found for diabetic men (HR, 2.45) and diabetic women (HR, 3.19) between 35 and 44 years of age. The sex-specific risks of hip fracture in diabetic men aged older than 74 years and diabetic women aged older than 84 years were similar to those of control subjects (HRs 0.98 and 0.91, respectively).

Diabetic men (HR, 1.43 versus 1.22) and women (HR, 1.82 versus 1.67) living in rural areas tended to have higher HRs of hip fracture than their urban counterparts.

"Given the potentially serious health and economic consequences of hip fracture, we must look into the underlying causes for increased risk of hip fracture among young and rural diabetic patients and implement a multifaceted intervention program accordingly to ensure the effective prevention of hip fracture in these high-risk diabetic populations," Dr. Li and colleagues recommend.