To Örebro University

Introduction: Previous research has indicated an elevated fracture incidence among individuals with T1D. The predominant hypothesis attributes this increased risk to a higher prevalence of osteoporosis.

Objectives: This study aims to compare the incidence of fractures in young T1D individuals vs controls and to explore the association between the frequency of hypoglycemic events and fracture incidence.

Methods: Data on 22,077 (55% males) individuals diagnosed with T1D before the age of 18 years were retrieved from the Swedish National Diabetes Register (NDR) and compared with 110,390 age- and sex-matched controls.

Results: There is a significantly increased risk of fractures in T1D individuals compared to controls (Figure1). This elevated risk isn´t seen before T1D diagnosis but is apparent already within the first few years after diagnosis. It is observed in both sexes, with females’ relative risk (RR) 1.4 (95%CI 1.35-1.47) and males’ RR 1.27 (95%CI 1.23-1.30) during the follow up period.

In the National Patient Register 0.56 hypoglycemic events/T1D individual with at least one fracture vs 0.3/T1D individual without any fracture were reported. Mean age in the fracture group was 27 years, compared to 22 years in the non-fracture group. A logistic regression model, adjusted for age and duration of T1D, still showed a significantly higher frequency of hypoglycemic events throughout the follow-up period (p < 0.03).

Conclusions: The increased incidence of fractures in individuals with T1D may, to some extent, be attributed to a higher risk of accidents resulting from hypoglycemic events. Continuous glucose monitoring systems with alarms could be crucial tools to reduce this risk.