Association Between Visit-to-Visit Fasting Plasma Glucose Variability and Osteoporotic Fractures in Nondiabetic Subjects

Context Although long-term glucose variability has been reported to be a risk factor associated with osteoporosis, there have been no previous studies between the relationship of glucose variability and fractures in people without diabetes. Objective We assessed visit-to-visit variations in fasting plasma glucose (FPG) as a prognostic factor in predicting osteoporotic fractures in individuals without diabetes. Methods Using a nationwide cohort database, we examined the impact of FPG on the development of osteoporotic fractures in men and women (aged >= 50 years). The primary outcomes were the number of total fractures and vertebral fractures. FPG variability was measured using standard deviation (FPG-SD), coefficient of variation (FPG-CV), and variability independent of the mean (FPG-VIM). Results Of the 92 929 participants, 5262 (5.7%) developed osteoporotic fractures during the mean follow-up of 8.4 years. Individuals in the highest quartile of FPG-SD showed an 11% and 16% increase in risk of total and vertebral fractures, respectively, compared with those in the lowest quartile after adjustment for mean FPG and other risk factors. Analyses using FPG-CV and FPG-VIM demonstrated similar results. Subgroup analyses and sensitivity analyses to explore potential heterogeneity showed consistent results. Conclusion FPG variability may be a novel risk factor for osteoporotic fractures independent of risk factors in the general population without diabetes.

Automated summary

Although previous studies have linked long-term glucose variability to osteoporosis, this study is the first to investigate the relationship between glucose variability and fractures in individuals without diabetes. The results suggest that fasting plasma glucose variability may be an independent risk factor for osteoporotic fractures in the general population without diabetes.