TOPLINE

Patients with type 1 diabetes (T1D) had a substantially higher risk for any fractures, major osteoporotic fractures, and hip fractures than matched control individuals without diabetes. The risk emerged as early as ages of 10-19 years, increased with worsening diabetic kidney disease (DKD), and remained elevated even in those without albuminuria.

METHODOLOGY

• Researchers conducted a cohort study to evaluate whether the risk for fractures (any fractures, major osteoporotic fractures, and hip fractures) was higher in patients with T1D, to assess the impact of different stages of DKD, and to identify clinical factors associated with the risk for fractures.
• T1D was defined as diabetes diagnosed before the age of 40 years with continuous insulin started within 1 year; 5035 patients with T1D from the FinnDiane Study and 12,286 matched control individuals without diabetes were included.
• DKD stages were classified on the basis of the urinary albumin excretion rate (UAER) from 24‑hour or timed overnight collections: normal UAER (< 20 μg/min or < 30 mg/24 h), moderate albuminuria (≥ 20 and < 200 μg/min or ≥ 30 and < 300 mg/24 h), severe albuminuria (≥ 200 μg/min or ≥ 300 mg/24 h in at least two of three consecutive urine collections), and kidney failure (dialysis or kidney transplant).
• The first occurrence of any fractures, any major osteoporotic fractures (hip, vertebral, wrist, and humerus fractures), and hip fractures was identified from Finnish national registers using diagnostic codes.
• The median follow-up duration was 32.8 years after the onset of T1D.

TAKEAWAY

• Among patients with T1D, 1981 had at least one fracture and 738 had a major osteoporotic fracture. Those with T1D had higher rates of fractures than control individuals, with a standardised incidence ratio (SIR) of 2.15 for any fractures, 2.60 for major osteoporotic fractures, and 5.24 for hip fractures.
• The risk for fractures increased stepwise with worsening kidney disease: The SIR was 2.54 in patients with normal albumin excretion and rose with the severity of DKD, reaching 5.08 in those with kidney failure; the risk for hip fractures was particularly high with kidney failure (SIR, 18.6). A similar trend was seen for major osteoporotic fractures.
• The excess risk appeared already at ages of 10-19 years and increased with age; among those younger than 30 years, most of the excess major osteoporotic fractures were wrist and humerus fractures, and the risk for hip fractures peaked at ages of 40-49 years.
• Factors linked to a higher risk for fractures included older age, more episodes of hypoglycaemic coma, and poor glycaemic control. A higher number of diabetic ketoacidosis episodes were associated with an increased risk for major osteoporotic fractures.

IN PRACTICE

"Based on our study, higher fracture risk is seen already in younger age-groups, and the 10-year cumulative risk of MOF [major osteoporotic fracture] at the age of 40 years in individuals with T1D exceeds the recommended threshold for BMD [bone mineral density] screening," the authors of the study wrote.

SOURCE

The study was led by Maija Feodoroff, Folkhälsan Research Centre, Helsinki, Finland. It was published online on July 27, 2026, in Diabetes Care.

LIMITATIONS

Some minor fractures treated in primary care before 2011 may not have been captured. The true difference in the risk for fractures may have been even greater than that observed. Moreover, the findings might not be generalisable to other populations with T1D and different ethnic backgrounds as the study population consisted predominantly of White individuals.

DISCLOSURES

The FinnDiane Study was supported by multiple sources, including the Folkhälsan Research Foundation, Wilhelm and Else Stockmann Foundation, Liv och Hälsa Society, and Medical Society of Finland. One author disclosed receiving investigator-initiated research grants and lecture fees and serving on advisory boards for multiple companies, including Medscape.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.