Endocrinol Metab.  2023 Dec;38(6):679-689. 10.3803/EnM.2023.1760.

Association between Smoking Status and the Risk of Hip Fracture in Patients with Type 2 Diabetes: A Nationwide Population-Based Study

• Lee SW
• Heu JY
• Kim JY
• Kim J
• Han K
• Kwon HS

• KMID: 2549261
• DOI: http://doi.org/10.3803/EnM.2023.1760

Abstract

Background
Limited longitudinal evidence exists regarding the potential association between smoking status and hip fracture among individuals with type 2 diabetes. We investigated this association using large-scale, nationwide cohort data for the Korean population.
Methods
This nationwide cohort study included 1,414,635 adults aged 40 and older who received Korean National Health Insurance Service health examinations between 2009 and 2012. Subjects with type 2 diabetes were categorized according to their smoking status, amount smoked (pack-years), number of cigarettes smoked per day, and duration of smoking. The results are presented as hazard ratios (HRs) and 95% confidence intervals (CIs) for the associations between smoking status parameters and risk of hip fracture in multivariable Cox proportional hazard regression analysis.
Results
Compared with never-smokers, an increased adjusted HR (aHR) for hip fracture was observed in current smokers (1.681; 95% CI, 1.578 to 1.791), and a comparable aHR for hip fracture was found in former smokers (1.065; 95% CI, 0.999 to 1.136). For former smokers who had smoked 20 pack-years or more, the risk was slightly higher than that for never-smokers (aHR, 1.107; 95% CI, 1.024 to 1.196). The hip fracture risk of female former smokers was similar to that of female current smokers, but the hip fracture risk in male former smokers was similar to that of male never-smokers.
Conclusion
Smoking is associated with an increased risk of hip fracture in patients with type 2 diabetes. Current smokers with diabetes should be encouraged to quit smoking because the risk of hip fracture is greatly reduced in former smokers.

Keyword

Fractures; Smoking; Diabetes mellitus, type 2; Complications

Figure

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  Fig. 1. Study design and disposition of subjects. NHIS, National Health Insurance System; FPG, fasting plasma glucose.

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  Fig. 2. Risk of hip fracture occurrence according to the cumulative amount of cigarettes smoked. Hazard ratios (HRs) were adjusted for age, sex, fasting glucose level, insulin use, use of three or more oral hypoglycemic agents, and duration of diabetes. Solid lines indicate adjusted HRs and dashed lines indicate 95% confidence intervals.

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  Fig. 3. Subgroup analysis regarding the risk of hip fracture in terms of age and sex. Hazard ratios (HRs) were adjusted for age, sex, fasting glucose level, insulin use, use of three or more oral hypoglycemic agents, and duration of diabetes.

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