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Fracture risk in type 2 diabetic patients: a clinical prediction tool based on a large population-based cohort

Fracture risk in type 2 diabetic patients: a clinical prediction tool based on a large population-based cohort
Fracture risk in type 2 diabetic patients: a clinical prediction tool based on a large population-based cohort

Background An increased fracture risk has been described as a complication of Type 2 diabetes mellitus (T2DM). Clinical prediction models for general population have a limited predictive accuracy for fractures in T2DM patients. The aim was to develop and validate a clinical prediction tool for the estimation of 5-year hip and major fracture risk in T2DM patients. Methods and results A cohort of newly diagnosed T2DM patients (n = 51,143, aged 50–85, 57% men) was extracted from the Information System for the Development of Research in Primary Care (SIDIAP) database, containing computerized primary care records for >80% of the population of Catalonia, Spain (>6 million people). Patients were followed up from T2DM diagnosis until the earliest of death, transfer out, fracture, or end of study. Cox proportional hazards regression was used to model the 5-year risk of hip and major fracture. Calibration and discrimination were assessed. Hip and major fracture incidence rates were 1.84 [95%CI 1.64 to 2.05] and 7.12 [95%CI 6.72 to 7.53] per 1,000 person-years, respectively. Both hip and major fracture prediction models included age, sex, previous major fracture, statins use, and calcium/vitamin D supplements; previous ischemic heart disease was also included for hip fracture and stroke for major fracture. Discrimination (0.81 for hip and 0.72 for major fracture) and calibration plots support excellent internal validity. Conclusions The proposed prediction models have good discrimination and calibration for the estimation of both hip and major fracture risk in incident T2DM patients. These tools incorporate key T2DM macrovascular complications generally available in primary care electronic medical records, as well as more generic fracture risk predictors. Future work will focus on validation of these models in external cohorts.

1932-6203
Martínez-Laguna, Daniel
330a147f-0b3a-41ff-8550-3dae76ac8ab2
Tebé, Cristian
3c2a2808-1123-47e5-a88f-c80df1405eb5
Nogués, Xavier
ceeef641-080b-4932-9c4f-1a2a5c73ff6c
Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Moreno, Victor
2b6b85df-9d99-4086-99c8-5cdb65d707b5
Diez-Perez, Adolfo
8161a0ff-36d3-4a32-9e06-9f119b59b492
Collins, Gary S.
91f7dc5f-6be2-42a2-9ed3-1dc47741ca95
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9
Martínez-Laguna, Daniel
330a147f-0b3a-41ff-8550-3dae76ac8ab2
Tebé, Cristian
3c2a2808-1123-47e5-a88f-c80df1405eb5
Nogués, Xavier
ceeef641-080b-4932-9c4f-1a2a5c73ff6c
Kassim Javaid, M.
12781b29-34fa-4158-837b-daf452b8d4ed
Cooper, Cyrus
e05f5612-b493-4273-9b71-9e0ce32bdad6
Moreno, Victor
2b6b85df-9d99-4086-99c8-5cdb65d707b5
Diez-Perez, Adolfo
8161a0ff-36d3-4a32-9e06-9f119b59b492
Collins, Gary S.
91f7dc5f-6be2-42a2-9ed3-1dc47741ca95
Prieto-Alhambra, Daniel
e596722a-2f01-4201-bd9d-be3e180e76a9

Martínez-Laguna, Daniel, Tebé, Cristian, Nogués, Xavier, Kassim Javaid, M., Cooper, Cyrus, Moreno, Victor, Diez-Perez, Adolfo, Collins, Gary S. and Prieto-Alhambra, Daniel (2018) Fracture risk in type 2 diabetic patients: a clinical prediction tool based on a large population-based cohort. PLoS ONE, 13 (9). (doi:10.1371/journal.pone.0203533).

Record type: Article

Abstract

Background An increased fracture risk has been described as a complication of Type 2 diabetes mellitus (T2DM). Clinical prediction models for general population have a limited predictive accuracy for fractures in T2DM patients. The aim was to develop and validate a clinical prediction tool for the estimation of 5-year hip and major fracture risk in T2DM patients. Methods and results A cohort of newly diagnosed T2DM patients (n = 51,143, aged 50–85, 57% men) was extracted from the Information System for the Development of Research in Primary Care (SIDIAP) database, containing computerized primary care records for >80% of the population of Catalonia, Spain (>6 million people). Patients were followed up from T2DM diagnosis until the earliest of death, transfer out, fracture, or end of study. Cox proportional hazards regression was used to model the 5-year risk of hip and major fracture. Calibration and discrimination were assessed. Hip and major fracture incidence rates were 1.84 [95%CI 1.64 to 2.05] and 7.12 [95%CI 6.72 to 7.53] per 1,000 person-years, respectively. Both hip and major fracture prediction models included age, sex, previous major fracture, statins use, and calcium/vitamin D supplements; previous ischemic heart disease was also included for hip fracture and stroke for major fracture. Discrimination (0.81 for hip and 0.72 for major fracture) and calibration plots support excellent internal validity. Conclusions The proposed prediction models have good discrimination and calibration for the estimation of both hip and major fracture risk in incident T2DM patients. These tools incorporate key T2DM macrovascular complications generally available in primary care electronic medical records, as well as more generic fracture risk predictors. Future work will focus on validation of these models in external cohorts.

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Accepted/In Press date: 22 August 2018
e-pub ahead of print date: 7 September 2018
Published date: 7 September 2018

Identifiers

Local EPrints ID: 423630
URI: https://eprints.soton.ac.uk/id/eprint/423630
ISSN: 1932-6203
PURE UUID: 29c7616a-0415-4a70-9784-414d28afe02f
ORCID for Cyrus Cooper: ORCID iD orcid.org/0000-0003-3510-0709

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Date deposited: 27 Sep 2018 16:30
Last modified: 10 Dec 2019 01:53

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