Sulfonylurea Use and Risk of Hip Fractures Among Elderly Men and Women with Type 2 Diabetes

Background Both increased age and type 2 diabetes mellitus are risk factors for developing bone fractures. While recent data in the elderly suggest a link between hypoglycemia and fall-related fractures, the association between sulfonylureas, commonly used hypoglycemic agents, and fracture risk has not been well investigated. Methods We used patient data from a large commercial health insurer from 2002-2005. Individuals aged >= 65 years receiving oral sulfonylurea treatment (n = 13,195) were matched 1:1 to non-users based on propensity for sulfonylurea use. Multivariable conditional logistic regression was used to estimate adjusted odds ratios (aOR) and 95 % confidence intervals (CIs). Results During an average 4 years of follow-up, sulfonylurea users experienced 226 incident hip fractures (1.7 %) and non-users experienced 157 (1.2 %). Sulfonylurea use was associated with increased risk of developing hip fracture (aOR 1.46, 95 % CI 1.17-1.82), and this association was apparent for men (120 cases; aOR 1.83, 95 % CI 1.25-2.66) and women (263 cases; aOR 1.32, 95 % CI 1.03-1.69). Patients with documented hypoglycemia in the follow-up period had increased odds of hip fracture relative to those without such diagnosis (aOR 2.42, 95 % CI 1.35-4.34). Conclusion Sulfonylureas are associated with increased risk of hip fracture in elderly men and women with type 2 diabetes.