Fracture trends and cost of fractures in patients with diabetes in Denmark

Annika Vestergaard Kvist*

*Corresponding author for this work

Research output: ThesisPh.D. thesis

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Abstract

Type 1 diabetes (T1D) and type 2 diabetes (T2D) are chronic illnesses that can result in several complications, including fragility fractures. Fracture risks are increased in T1D and T2D. Decreasing fracture incidence rates (IRs) have been demonstrated in the general population in Denmark, although information about the patterns among persons with T1D or T2D was lacking. Additionally, trends for site-specific fracture IRs were unknown. Moreover, persons with T1D have a higher prevalence of complications after fractures, which could elevate the healthcare cost of fracture treatment, implying higher costs in T1D. Although, it was unknown if there are differences in the costs between persons with T1D and persons without diabetes mellitus (DM).

Therefore, the aims of this project were firstly to investigate fracture incidence rates (IRs) in persons with T1D, T2D, and without DM, including differences in sexes, age groups, and fracture sites, and secondly to estimate the direct healthcare costs and cost drivers of fracture treatment among persons with T1D compared to persons without DM.

A combination of Danish registries was used to estimate fracture IRs and cost of fractures in persons with T1D. Population-based sequential cross-sectional designs were applied to estimate fracture IRs and trends of fractures, while population-based cohort designs were used to estimate costs of fractures.

Fracture IRs in persons aged 18 years or above with T1D, T2D and controls with a fracture in the period 1997 to 2017 were calculated. Median IRs of the first five years and the last five years were calculated and compared. Furthermore, direct healthcare costs of hip, humerus, forearm, foot, and ankle fractures occurring between 2011- 2015 in individuals aged 18 years or above with T1D and matched controls were calculated.

The investigations demonstrated declines in fracture IRs, which decreased most substantially in persons with T2D below the age of 50 years. Decreasing fracture IRs were also discovered in men with T1D, but not in women with T1D. Vertebral fracture IRs increased, while hip fracture IRs decreased for persons with T1D, T2D, and without DM. Additionally, forearm and humerus fracture IRs decreased in persons with T1D and T2D. Furthermore, direct healthcare costs of humerus, forearm, foot, and ankle fracture treatment were higher among persons with T1D compared to persons without DM, although no difference of healthcare cost of hip fracture treatment was identified. The healthcare costs of fracture treatment were primarily driven by longer durations of hospitalization.

The mechanisms behind declining fracture IRs. Declining fracture trends in T1D and T2D could be due to improvements in disease management and lifestyle, as well as increasing BMI and lower prevalence of hypoglycaemia. The risk of sustaining a fracture is still elevated among persons with T1D or T2D, therefore, it remains highly important to study the mechanisms behind the risk, which may help optimizing prevention of fractures. The mechanisms behind higher fracture treatment costs are unknown, but higher healthcare costs of fracture treatment in persons with T1D could be explained by higher prevalence of complications after in persons with T1D compared to persons without DM. This is why improvements in fracture treatment in this group might lower the costs of fracture treatment and improve the quality of life for the patients. 
Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Nielsen, Morten Frost, Principal supervisor
  • Burden, Andrea M., Co-supervisor, External person
  • Vestergaard, Peter, Co-supervisor, External person
Date of defence20. Dec 2024
Publisher
DOIs
Publication statusPublished - 17. Oct 2024

Note re. dissertation

Print copy of the full thesis is restricted to reference use in the library.

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