Losada Grande, Eladio JHawley, SamuelSoldevila, BertaMartinez-Laguna, DanielNogues, XavierDiez-Perez, AdolfoPuig-Domingo, ManelMauricio, DidacPrieto-Alhambra, Daniel2021-08-252021-08-252017-06-19Losada-Grande E, Hawley S, Soldevila B, Martinez-Laguna D, Nogues X, Diez-Perez A, et al. Insulin use and Excess Fracture Risk in Patients with Type 2 Diabetes: A Propensity-Matched cohort analysis. Sci Rep. 2017 Jun 19;7:3781.2045-2322https://hdl.handle.net/20.500.13003/15972Despite normal to high bone mineral density, patients with type 2 diabetes (T2DM) have an increased fracture risk. T2DM medications could partially account for this excess risk. The aim of this study was to assess the association between insulin use and bone fracture risk in T2DM patients. A population-based matched cohort study based on a primary care records database validated for research use (Catalonia, Spain) was performed. Propensity score (PS) for insulin use was calculated using logistic regression including predefined predictors of fractures. A total of 2,979 insulin users and 14,895 non-users were observed for a median of 1.42 and 4.58 years respectively. Major fracture rates were 11.2/1,000 person-years for insulin users, compared with 8.3/1,000 among non-users. Matched models confirmed a significant association, with an adjusted subhazard ratio (adj SHR) of 1.38 [95% CI 1.06 to 1.80] for major fractures. No differences between types of insulin or different regimens were found. Estimated number needed to harm (fracture) was 82 (95% CI 32 to 416). Insulin use appears to be associated with a 38% excess fracture risk among T2DM patients in the early stages of the disease. Fracture risk should be included among the considerations to initiate insulin treatment.engAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/Propensity ScoreDatabases, FactualMaleMiddle AgedModels, BiologicalHumansInsulinSpainCase-Control StudiesAgedFractures, BoneDiabetes Mellitus, Type 2Femaleresearch articleEstudios de Casos y ControlesFracturas ÓseasBases de Datos FactualesFemeninoMasculinoInsulinaPuntaje de PropensiónHumanosPersona de Mediana EdadModelos BiológicosAncianoDiabetes Mellitus Tipo 2EspañaAgedCase-Control StudiesDatabases, FactualDiabetes Mellitus, Type 2FemaleFractures, BoneHumansInsulinMaleMiddle AgedModels, BiologicalPropensity ScoreSpain10.1038/s41598-017-03748-z28630427L6255098812-s2.0-85021085509000403650300024open access