Association Between Visit-to-Visit Fasting Plasma Glucose Variability and Osteoporotic Fractures in Nondiabetic Subjects

The impact of fasting plasma glucose variability on osteoporotic fractures

Purpose

To investigate the impact of FPG variability on osteoporotic fractures in the entire community population.

Methods

All participants were from the Kailuan Study. Participants completed three consecutive surveys from 2006-2007, 2008-2009, and 2010-2011. We excluded individuals with an osteoporotic fracture in or prior to the index year and those without complete FPG records at the first 3 examinations. All participants were followed from the date of the 3rd examination to the first occurrence of an endpoint event or December 31, 2021. According to the SD of FPG levels, the included subjects were divided into three groups. A Cox proportional hazards model was performed to further analyze the effect of different FPG-SD groups on the risk of osteoporotic fractures.

Results

Ultimately, the study population included 57295 participants. During a median follow-up time of 11.00 years, we documented 772 new osteoporotic fracture cases. When evaluating the FPG-SD level as a categorical variable, the HRs for osteoporotic fractures were 1.07 (95% CI: 0.89-1.29) for T2 and 1.32 (95% CI: 1.10-1.60) for T3 when compared with T1. We found that increased FPG variability was associated with a greater risk of osteoporotic fractures in people with diabetes than in those without diabetes (47% vs. 32%).

Conclusion

Increased FPG variability was an independent predictor of incident osteoporotic fracture, especially in individuals older than 50 years old, nonobese individuals, diabetes patients, and individuals with positive FPG-SD variability.

Association between trajectories of fasting plasma glucose and risk of osteoporosis in non-diabetic and diabetic populations

Introduction

Previous studies based on a single measure of fasting plasma glucose (FPG) showed an inconsistent conclusion about the association between FPG and osteoporosis risk. Not accounting for time-varying and cumulative average of FPG over time could bias the true relation between FPG and osteoporosis. Our study aims to investigate the association between the trajectories of FPG and osteoporosis risk for non-diabetic and diabetic populations.

Methods

A total of 18,313 participants who attended physical examinations during 2008-2018 were included. They were free of osteoporosis at their first physical examination and followed until their last physical examination before December 31, 2018. We recorded their incidence of osteoporosis and at least three FPG values during follow-up. Their longitudinal FPG trajectories were identified by the latent class growth analysis model based on the changes in FPG. Multivariable logistic regression models were used to analyze the association between the trajectories of FPG and osteoporosis diagnosed in the follow-up physical examination in both non-diabetics and diabetics.

Results

There were 752 incident osteoporosis among 16,966 non-diabetic participants, and 57 incident osteoporosis among 1,347 diabetic participants. Among non-diabetics, the elevated-increasing FPG trajectory was negatively associated with osteoporosis risk in women (odds ratio (OR), 0.62; 95% confidence interval (CI), 0.43-0.88). Premenopausal women with elevated-increasing FPG trajectory had lower osteoporosis risk than those women with normal-stable FPG trajectory (OR, 0.41; 95% CI, 0.20-0.88), while this association was insignificant in postmenopausal women. Among diabetics, those whose longitudinal FPG is kept at a very high level had the highest risk of osteoporosis (OR, 3.09; 95% CI, 1.16-8.22), whereas those whose FPG starts with the high level and keeps on increasing did not exhibit a significantly increased risk (OR, 1.75; 95% CI, 0.81-3.76) compared with those who keep stable moderate-high level of FPG, except in men (OR, 2.49; 95% CI, 1.02-6.12).

Conclusion

Distinct trajectories of FPG are associated with differential risk of osteoporosis in non-diabetic and diabetic populations. Controlling a proper FPG level in different populations is necessary for osteoporosis prevention.

Positive association of fasting plasma glucose with bone mineral density in non-diabetic elderly females

INTRODUCTION

Previous studies involving diabetics have shown different associations between fasting plasma glucose (FPG) and bone mineral density (BMD). The different effects of FPG on BMD are due to varying effects of antidiabetic drugs, glycemic control and diabetic complications in the diabetic patients. It is necessary to identify the association in subjects without diabetes.

MATERIALS AND METHODS

A total of 2367 females over 65 were included in this cross-sectional study. Subjects were grouped by FPG quartile. BMD and the prevalence of osteoporosis were compared among different FPG quartiles. Multiple logistic regression was used to analyze the independent contribution of FPG to osteoporosis.

RESULTS

Subjects in lower FPG quartile had lower BMD (P < 0.05). Subjects with osteoporosis had a lower FPG than the subjects of osteopenia, and both were lower than subjects with normal bone mass (P < 0.001 for all). Compared with the lowest FPG quartile, subjects in the 3rd and the 4th quartiles have a lower risk of osteoporosis in the lumbar spine (OR 0.77, 95% CI 0.59-0.98; OR 0.76, 95% CI 0.56-0.99, respectively), the total hip (OR 0.72, 95% CI 0.56-0.96; OR 0.75, 95% CI 0.53-0.99, respectively), and the femoral neck (OR 0.73, 95% CI 0.50-0.97; OR 0.71, 95% CI 0.54-0.92, respectively) after adjustment for age, BMI, education, physical activity and menopausal age.

CONCLUSION

FPG was positively associated with BMD in non-diabetic elderly females. Low FPG may increase the risk of osteoporosis in the non-diabetic elderly females in China.

Incidence rate and factors associated with the development of secondary cancers after radioiodine therapy in differentiated thyroid cancer: a multicenter retrospective study

PURPOSE

The objective of this study was to estimate the incidence of secondary cancers and the factors associated with their development among patients who underwent radioiodine therapy (RIT) with differentiated thyroid cancer.

METHODS

We retrospectively collected medical records for patients who underwent first RIT between January 1, 2000, and December 31, 2005, from seven tertiary hospitals in South Korea after total thyroidectomy for differentiated thyroid cancer. Cancer incidence and calculated standardized rate ratio were compared with Korean cancer incidence data. The association between the development of secondary cancers and various parameters was analyzed by Cox-proportional hazard regression.

RESULTS

A total of 3106 patients were included in this study. Mean age at the time of diagnosis of thyroid cancer was 45.7 ± 13.3 years old, and 2669 (85.9%) patients were female. The follow-up period was 11.9 ± 4.6 (range, 1.2-19.6) years. A total of 183 secondary cancers, which included 162 solid and 21 hematologic cancers, occurred in 173 patients (5.6%). There was no significant difference between solid cancer incidence in our study population who underwent RIT and the overall Korean population, but the incidence of hematologic cancers and total cancer in our study was significantly higher compared with that of the Korean population. A multivariate analysis identified independent prognostic factors for the development of secondary cancer including age at 1st RIT, male, and total cumulative dose over 200 mCi.

CONCLUSION

We need to assess the risk benefit for patients who receive over 200 mCi of a total cumulative dose.