@article{ref1,
title="The diabetes-fracture association in women with type 1 and type 2 diabetes is partially mediated by falls: a 15-year longitudinal study",
journal="Osteoporosis international",
year="2021",
author="Teede, H. J. and Mishra, G. D. and Ebeling, P. R. and Joham, A. E. and Enticott, J. C. and Milat, F. and Thong, E. P.",
volume="ePub",
number="ePub",
pages="ePub-ePub",
abstract="This study evaluated mediators of fracture risk in postmenopausal women with type 1 (T1D) and type 2 diabetes (T2D), over a 15-year follow-up period. This study  provides evidence that the increased fracture risk in women with T1D or T2D is  partially explained by falls. Furthermore, a shorter reproductive lifespan in women  with T1D contributes modestly to fracture risk in this cohort. <br><br>PURPOSE: Skeletal  fragility is associated with diabetes mellitus, while limited estrogen exposure  during the reproductive years also predisposes to lower bone mass and higher  fracture risk. We aimed to determine osteoporosis diagnosis, fall and fracture rates  in women with type 1 (T1D) and type 2 (T2D) diabetes mellitus, and explore mediators  of the diabetes-fracture relationship. <br><br>METHODS: Prospective observational data drawn  from the Australian Longitudinal Study in Women's Health (ALSWH) from 1996 to 2010. Women were randomly selected from the national health insurance database. Standardized data collection occurred at six survey time points, with main outcome  measures being self-reported osteoporosis, incident fracture, falls, and  reproductive lifespan. Mediation analyses were performed to elucidate relevant  intermediaries in the diabetes-fracture relationship. <br><br>RESULTS: Exactly 11,313 women  were included at baseline (T1D, n = 107; T2D, n = 333; controls, n = 10,873). A  total of 885 new cases of osteoporosis and 1099 incident fractures were reported  over 15 years. Women with T1D or T2D reported more falls and fall-related injuries;  additionally, women with T1D had a shorter reproductive lifespan. While fracture  risk was increased in women with diabetes (T1D: OR 2.28, 95% CI 1.53-3.40; T2D: OR  2.40, 95% CI 1.90-3.03), compared with controls, adjustment for falls attenuated the  risk of fracture by 10% and 6% in T1D and T2D, respectively. In women with T1D,  reproductive lifespan modestly attenuated fracture risk by 4%. <br><br>CONCLUSION: Women  with T1D and T2D have an increased risk of fracture, which may be partially  explained by increased falls, and to a lesser extent by shorter reproductive  lifespan, in T1D.<p /> <p>Language: en</p>",
language="en",
issn="0937-941X",
doi="10.1007/s00198-020-05771-9",
url="http://dx.doi.org/10.1007/s00198-020-05771-9"
}