Incidence and risk factors for osteoporosis in people with type 2 diabetes mellitus in Thailand

Background: Type 2 diabetes mellitus (T2DM) is documented to alter bone structure and increase fracture risk. This study aimed to determine the risk factors and incidence rate of osteoporosis in Thai adults with T2DM. Methods: A retrospective cohort study was conducted at Ramathibodi Hospital. People aged 18 or above whom were diagnosed with T2DM between January 2010 and December 2019 and started diabetic medication were included. Participants with a history of osteoporosis were excluded. Osteoporosis was diagnosed by BMD T-score ≤ -2.5, ICD10 for osteoporosis, ICD9 for fragility fracture, or prescription of osteoporosis medication. The participants that did not meet the criteria would be categorized as non-osteoporosis. Univariate and multivariate Cox regression analyses were used to determine risk factors for osteoporosis. Results: 25,635 participants were recruited. 772 participants were diagnosed with osteoporosis during the study period. The incidence rate was 57/10,000 person-year. Older age and female sex were associated with a greater risk for osteoporosis with hazard ratios (HR) of 1.07 (1.06-1.08) and 4.30 (3.48-5.30) respectively, while higher BMI was associated with a reduction in osteoporosis [HR 0.95 (0.94-0.97)]. For Diabetes-related risk factors, dipeptidyl peptidase-4 inhibitors (DPP4-inhibitors), insulin, sulfonylureas, and thiazolidinediones were related with an increased risk of osteoporosis, HR were 1.41 (1.09-1.81), 1.34 (1.07-1.69), 1.22 (1.01-1.48) and 1.45 (1.05-1.99)respectively. Dyslipidemia is also associated with osteoporosis [HR 1.36 (1.12-1.66)]. Conclusion: Older women with T2DM and dyslipidemia had a significantly higher risk of osteoporosis. Furthermore, insulin, sulfonylureas, thiazolidinediones, and DPP4-inhibitors are associated with increased fracture risk when compared to metformin.