Article Title: Prediabetes and Fracture Risk Among Midlife Women in the Study of Women’s Health Across the Nation

Journal Title: The Journal of the American Medical Association (JAMA)

Publication Year: 2023

Author(s): Shieh et. Al

Study Description:

Fractures and bone disease are recognized as a complication of diabetes; however, it is uncertain whether prediabetes is associated with an increased risk of fractures. This is a longitudinal cohort study consisting of 1,690 midlife women (premenopausal or early perimenopause) who did not have type II diabetes prior to the menopause transition. This study defined menopause transition as the first visit in late perimenopause. These women were followed for a mean of 12 years and at each follow up visit fracture occurrence and location were collected using questionnaires. This study included both atraumatic fractures (from a fall of less than 15.2 cm and not occurring from sports, heavy impact, rapid movement or MVA) and traumatic fractures. The goal of this study was to determine if prediabetes can be considered a risk factor for future fractures.

Outcomes: The outcome studied was fracture occurrence. Of 1,690 women, 225 women had prediabetes and the remaining did not. Of the 225 women who had prediabetes, 25 (11.1%) sustained subsequent fracture compared to 111 of the 1,465 (7.6%) in the women without prediabetes.

Hazard ratio for fracture w/ prediabetes at all pre MT visits compared to no pre MT visits was 2.20 = 120%

Other findings: The majority of fractures in this cohort of women were found to be in the hand and foot area. These fractures can cause a 2x greater risk of subsequent vertebral or hip fractures.

Conclusion: Prediabetes was associated with an increased risk of fracture in midlife women.

Limitations:

1. Both minimal trauma and traumatic fracture were included in a composite outcome to maximize fracture outcomes. However, studies have shown that both minimal trauma and traumatic fracture types are associated with future fractures.
2. The rates of prediabetes & fractures were found to differ by race/ethnicity. However, this study was unable to examine the association between prediabetes and fractures regarding race and ethnicity.

Clinical Applicability:

This study can help guide clinical practice by establishing prediabetes as a modifiable risk factor for fractures. Today, clinicians debate on whether to treat prediabetes. This study can help to encourage future research into examining whether treating prediabetes before the menopause transition period can reduce the risk of subsequent fracture outcomes. This study can also help to enforce the need for early bone health interventions such as weight-bearing exercises, smoking cessation, vitamin D/calcium supplementation, etc in the pre-menopausal female population.

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