Associations between presence of diabetes, mortality and fracture type in individuals with a hip fracture. (October 2022)

• Record Type: Journal Article
• Authors: Spaetgens, Bart; Brouns, Steffie H.A.; Linkens, Aimée E.M.J.H.; Poeze, Martijn; ten Broeke, René H.M.; Brüggemann, Renée A.G.; Sipers, Walther; Henry, Ronald M.A.; Hanssen, Nordin M.J.
• Is Part Of: Diabetes research and clinical practice. Volume 192(2022)
• Publication Date: 2022-10
• Subjects: Diabetes -- Hip fractures -- In-hospital complications -- Older individuals; Diabetes -- Periodicals; Diabetes Mellitus -- Periodicals; 616.462
• DOI: 10.1016/j.diabres.2022.110084
• Languages: English
• ISSNs: 0168-8227

Abstract

Highlights: Patients with diabetes display a greatly increased mortality risk after hip fracture. This increased mortality is not explained by fracture type or comorbidities. Hip fractures may be considered as yet another diabetes-associated complication. In-and-out of hospital efforts in diabetes care are needed to reduce excess mortality. Abstract: Aims: An overlooked aspect of diabetes is an increased risk of hip fractures, with associated mortality. We investigated whether fracture type and/or burden of comorbidities explains the increased risk of mortality in diabetes after hip fracture. Methods: For this cohort study, we used a de-identified data set of hip fracture patients registered in a quality-of-care registry (2017/2018) included in Maastricht University Medical Centre. Results: Among 594 hip fracture patients, 90 (15.2 %) had diabetes. Median (IQR) age was 82 (71–87) years and 63.8 % were women. Compared to patients without, patients with diabetes had higher median Charlson Comorbidity Index [1 (0–2) vs 0 (0–2), P < 0.001)] and were more likely to sustain intertrochanteric/subtrochanteric fractures [54.4 vs 38.7 %, P = 0.02]. Over a median follow-up of 2.7 (1.6–3.3) years, crude mortality rate was 30.8 % in patients without and 50.0 % in patients with diabetes. This association remained unaltered after adjustment for age, sex, BMI, fracture type or burden of co-morbidities. Conclusion: Individuals with diabetes display a greatly increased absolute mortality risk after hip fracture. This association was not attenuated after adjustment for fracture type or non-diabetes associated co-morbidity. These findings have important implications for diabetes care in hip fracture patients, and underline the importance of fracture prevention.