Systemic glucocorticoid use increases fracture risk similarly in individuals with and without type 2 diabetes: a Danish nationwide cohort study

This Danish nationwide cohort study used registry data on nearly 478,000 people who started systemic glucocorticoids (about 28,000 with type 2 diabetes) to see whether diabetes makes glucocorticoid-related fracture risk worse. Using a within-person before/after design with statistical weighting, glucocorticoids raised major osteoporotic fracture risk substantially (adjusted IRR 1.70, 95% CI 1.55-1.85), but this increase was essentially the same in people with and without type 2 diabetes (interaction/product term IRR 1.01, 95% CI 0.87-1.17), and this held across sex, age, fracture site, and multiple sensitivity analyses.

AI summary · from the full text · reviewed by Pukhraj Gaheer, Medical Student, Queen's University before publishing

Why it mattersClinicians often assume diabetic patients face extra glucocorticoid-related fracture risk, but this large study suggests the relative risk increase is similar, meaning fracture prevention counseling should focus on glucocorticoid exposure itself rather than diabetes status as an added multiplier.

Presenting this at rounds? Start here

• ?Should orthopedic surgeons and endocrinologists treat glucocorticoid-associated fracture risk the same way in diabetic and non-diabetic patients, given that the relative risk increase appears similar despite diabetics' higher baseline risk?
• ?Given that fracture risk from glucocorticoids was highest early in treatment and with higher doses, how should this inform timing of DXA screening or bone-protective therapy initiation after starting steroids?