Abstract: PUB091
Impact of Type 2 Diabetes Mellitus and CKD on Bone Mineral Density in Elderly Patients with Hip Fractures
Session Information
Category: Bone and Mineral Metabolism
- 502 Bone and Mineral Metabolism: Clinical
Authors
- Roy, Debajyoti M., Changi General Hospital, Singapore, Singapore, Singapore
- Ng, Chee Yong, Changi General Hospital, Singapore, Singapore, Singapore
- Vasudevan, Vyjayanti, Singapore American School, Singapore, Singapore, Singapore
- Koduri, Sreekanth, Changi General Hospital, Singapore, Singapore, Singapore
- Yeon, Wenxiang, Changi General Hospital, Singapore, Singapore, Singapore
Background
Diabetes mellitus (T2DM) and chronic kidney disease (CKD) are common medical conditions in the elderly and have been associated with increased risk of bone fractures due to their negative impact on bone quality.
When DM and CKD occur in combination, the negative impact on BMD may be greater due to the complex interplay between the two conditions.
This study investigates potential differences in the impact of T2DM and CKD on BMD in elderly patients with fragility hip fracture when these conditions occur alone versus when in combination. We also investigate the relationship of worsening HBA1c to BMD in the groups with and without CKD .
Methods
A cross-sectional study was conducted on 715 elderly patients (age ≥65 years) with fragility hip fracture admitted to a hospital between Jan 2018 and Dec 2020. The study population was divided into four groups: Group 1 - No CKD or Diabetes (n=201), group 2 - No CKD with diabetes present (n=188), group 3 - CKD present with no diabetes (n=166), group 4 - Both CKD and diabetes present (n=160). BMD was measured using dual-energy X-ray absorptiometry (DXA) at the femoral neck. The data were analyzed using analysis of variance (ANOVA) and post-hoc testing with Bonferroni correction.
Results
The mean age of the study population was 75.6±6.8 years, and 62.5% were female. The mean body mass index (BMI) was 25.1+/-3.7 kg/m2. Of the cohort 326 had CKD & 160 T2DM. Table 1 depicts patient groups and variables
Conclusion
1.In elderly patients with hip fracture,Group 2(T2DM+/CKD-) T score was higher as compared to Group 1 (T2DM-/CKD-).
2.There is a positive linear association between higher HBA1C and T score in Group 2 (T2DM+/CKD-).This association is however lost in the presence of CKD.
3.The post operative LOS was longer in Group 4 (CKD+/T2DM+) , 10.4 days compared to Group 1 (T2DM-/CKD-), 8.6 days ( P-0.04).
Table : Patient variables
| Variables | Group 1 (CKD-/T2DM-) n=201 | Group 2 (CKD-/T2DM+) n=188 | Group 3 (CKD+/T2DM-) N=166 | Group 4(CKD+/T2DM+) N=160 | p value (ANOVA) |
| eGFR | 60(0.17) | 60(0.0) | 47(20.0) | 44(16.5) | <0.001 |
| Albumin (g/L) | 37(6) | 37(6) | 37(7.0) | 36(5.0) | 0.12 |
| HBA1c | - | 6.8(1.7) | - | 6.4(1.6) | <0.0001 |
| Calcium (mmol/L) | 2.2(0.1) | 2.3(0.1) | 2.3(0.2) | 2.2(0.1) | 0.19 |
| Phosphate (mmol/L) | 1.1(0.3) | 1.1(0.3) | 1.1(0.3) | 1.1(0.3) | 0.06 |
| 25(OH)D | 21.8(17.4) | 22.3(16.6) | 24.4(18.6) | 21.1(17.2) | 0.10 |
| T score (hip) | -3.2(1.2) | -2.9(1.3) | -3.2(1.4) | -3(1.4) | 0.03 |
| LOS (days) | 8.6(6) | 8.9(6.5) | 9.7(6.5) | 10.4(6.9) | 0.02 |
Funding
- Clinical Revenue Support