Intensive glycemic control and fracture risk [abstract 1352-P] Abstract uri icon
Overview
abstract
  • Older adults with type 2 diabetes are at higher risk of fractures. Effect of glycemic control on fracture risk is unknown. Better control reduces complications and may preserve bone but hypoglycemia may increase the risk of injurious falls. To determine the effect of intensive (INT) versus standard (STD) glycemic control on fracture risk, the ACCORD BONE ancillary study assessed fractures as an outcome in the ACCORD trial. ACCORD participants were assigned to INT or STD and to a subtrial, the Blood Pressure (BP) trial, comparing intensive to standard BP control, or the Lipid trial, comparing statin plus fenofibrate to statin plus placebo. ACCORD achieved a median A1C of 6.4% (INT) and 7.5% (STD). A higher proportion of those in INT (92%) were prescribed thiazolidinediones (TZD), reported to increase fractures in women, compared with STD (58%), and hypoglycemic episodes requiring assistance occurred more often in INT (16.2% vs 5.1%). BONE included 54 of 77 ACCORD clinical sites (7,282 of 10,251 participants). Non-spine fracture events were centrally and blindly adjudicated using radiology reports. These analyses are limited to confirmed fractures that occurred before close of the INT arm, an average follow-up of 3.8 years. Proportional hazards models were used to compare time to first fracture in the INT and STD groups. There was no effect of INT, compared with STD, on non-spine fracture rate (HR = 1.04; 95% CI 0.86-1.27) or on rates of hip, ankle or wrist fractures. There was an interaction between INT and Lipid trial arm (p=0.002). INT compared with STD reduced fractures (HR = 0.50; 95% CI 0.32-0.77) in those assigned to “statin plus placebo” in the Lipid trial, but had no effect on fractures in the “statin plus fibrate” group (HR = 1.25; 95% CI 0.85-1.84) or in the BP Trial (HR=1.32; 95% CI 0.99-1.76). Plausible reasons for this unexpected interaction are not evident, and it may be due to chance. Compared with STD, INT was associated with increased mortality, more frequent hypoglycemia and TZD use, and reduced some microvascular complications, but INT had no net effect on fracture risk in ACCORD. Future analyses will assess the independent effects of glycemic control, TZDs, and hypoglycemia on fractures.

  • publication date
  • 2011
  • published in
  • Diabetes  Journal
  • Research
    keywords
  • Diabetes
  • Disease Management
  • Drugs
  • Fractures
  • Randomized Controlled Trials
  • Risk Factors
  • Additional Document Info
    volume
  • 60
  • issue
  • Suppl 1