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Prediabetes in midlife may be a modifiable risk factor for later fractures in women, investigators report.

Study participants included 1,600 diverse, ambulatory women in the Study of Women’s Health Across the Nation cohort, whose health outcomes were tracked between 1996 and 2018. Participants were in premenopause or early perimenopause, did not take bone strengthening medications and did not have type 2 diabetes at baseline.

Significant risk

Prediabetes before menopause was associated with a higher likelihood of subsequent fractures, investigators found. For example, women who had prediabetes at 50% or 100% of their followup visits before menopause had a 49% and 120% greater likelihood of fracture both during and after menopause, respectively. These study participants were likely to have approximately 3 and 7 more fractures per 1,000 person-years during this time when compared to the fracture hazard of 6.3 fractures per 1,000 person-years for women with no prediabetes.

Notably, fracture risk was not associated with type 2 diabetes. But similar to type 2 diabetes, the link between fracture and prediabetes was independent of bone mineral density.

Recommended approach

About 1 in 3 adults in the United States has prediabetes, but these cases do not always progress to diabetes. Clinicians therefore disagree on how aggressively to treat it, the researchers wrote. They noted, however, that most fractures in the study occurred at nonhip, nonvertebral sites — the type of fractures that are associated with a twofold greater risk of subsequent vertebral or hip fracture.

“Thus, for this population, prediabetes before the menopause transition may be an early, modifiable risk factor for fracture,” they concluded.

Full findings were published in JAMA Network Open.

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