Incidence Rate and Associated Factors of Osteoporotic Fractures in Type 2 Diabetes Mellitus Patients; A Retrospective Cohort Study in Khoksamrong Hospital, Khoksamrong District, Lopburi Province, Thailand

Abstract

Background: Osteoporotic fractures are a significant health concern in patients with type 2 diabetes mellitus (T2DM), who exhibit a higher fracture risk despite increased bone mineral density. This paradox is attributed to compromised bone quality and diabetes-related complications. In Thailand, especially in rural settings, data remain limited. This study aims to investigate the incidence and associated factors of osteoporotic fractures in T2DM patients at Khoksamrong Hospital, Lopburi Province, Thailand.
Methods: This research is a quantitative study conducted through a retrospective cohort study design, analyzing medical records of outpatients, inpatients, and chronic disease clinic patients at Khoksamrong Hospital from 2019 to 2024. The study aims to examine factors associated with osteoporotic fractures in T2DM patients at Khoksamrong Hospital, Khoksamrong District, Lopburi Province, Thailand.
Results: This study included 67.63% male patients. Over half were aged ≥65 years (53.73%). Obesity grades 1 and 2 accounted for 29.36% and 16% of participants, respectively. The most common fracture site was the hip (40.5%), followed by the radius (23.3%), ribs (20.7%), ankle (9.5%), vertebrae (3.4%), and humerus (2.6%). Females had a higher fracture rate (8.10%) than males (4.65%), and patients ≥65 years had a higher fracture rate (8.06%) than those <65 years (5.72%). Underweight patients showed the highest fracture rate (9.65%). Significant risk factors for osteoporotic fractures included uncontrolled fasting blood glucose (adjusted IRR = 2.02; 95% CI: 1.37–2.96; p < 0.002), fall history (IRR = 2.15; p < 0.001), hypertension (IRR = 2.72; p < 0.001), and dyslipidemia (IRR = 2.09; p = 0.004). CKD showed a non-significant trend (IRR = 1.86; p = 0.077). No significant associations were observed for sex, age, smoking, alcohol use, BMI, or HbA1c control after adjustment.
Conclusion: Osteoporotic fracture risk among T2DM patients is significantly associated with poor glycemic control, fall history, hypertension, and dyslipidemia. Early identification and management of these modifiable factors are crucial to reducing fracture risk in this population.