Insights from secular trend of major osteoporotic fractures in people with and without diabetes: 15-year population-based study (2009 - 2023).

Authors

David T W Lui, Xincheng Zou, Chi-Ho Lee, Wing-Sun Chow, Carol H Y Fong, Mstat Chloe Y Y Cheung, Ka-Shing Cheung, Andrew Y Y Ho, Benjamin Y T Au Yeung, Tin-Wai Wong, Suet-Ming Chau, Chiu-Chi Tsang, Chi-Kin Yeung, Xi Xiong, Carlos K H Wong, Tai-Pang Ip, Kathryn C B Tan, Yu-Cho Woo, Karen S L Lam, Manju Chandran

Published in

Endocrine practice : official journal of the American College of Endocrinology and the American Association of Clinical Endocrinologists. Jul 04, 2026. Epub Jul 04, 2026.

Abstract

This study aims to evaluate changes in the epidemiology of major osteoporotic fractures(MOF) stratified by diabetes status over 15years in a population-based cohort.
Individuals aged≥50years who sustained MOF between 2009 and 2023 identified from territory-wide electronic health database, stratified by diabetes status. Records of HbA1c, hypoglycemic episodes, and osteoporosis screening and treatments were retrieved. Ratios of rates of MOF, osteoporosis screening and treatments between the diabetes and non-diabetes groups were calculated to reflect the disparity between two groups. Secular trends were reported in average annual percentage change(AAPC) using joinpoint regression. All rates were age-standardized to the 2021 Hong Kong Census mid-year population.
86263 hip fractures and 124268 non-hip fractures were recorded during the study period. Although annual age-standardized incidence of hip fractures decreased, rate ratios between diabetes and non-diabetes remained static at 4.1 for women(AAPC -0.16%,95%CI -0.65 to +0.35,p=0.54) and 2.5 for men(AAPC +0.07%,95%CI -0.58 to 0.71,p=0.83), suggesting persistent gap of diabetes-specific excess fracture risk. This gap was similarly observed for non-hip fractures. Over the years, age-standardized mean HbA1c improved from 59 mmol/mol(7.5%) to 53 mmol/mol(7%), along with fewer severe hypoglycemic episodes. Prevalence of individuals with screening dual-energy x-ray absorptiometry performed increased, more so in women with diabetes. Anti-osteoporosis medication prescriptions increased in both diabetes and non-diabetes, but increased to a lesser extent in the diabetes population.
Diabetes-specific excess fracture risk persisted despite improved glycemic control. Despite increasing efforts of osteoporosis screening in diabetes, this has not translated into more aggressive treatment of bone fragility in diabetes.

PMID:
42401205
Bibliographic data and abstract were imported from PubMed on 05 Jul 2026.

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