Type 2 Diabetes Is Associated With Increased Complications and Mortality After Hip Fracture in Older Adults Aged 60 Years or Older

AIMS: Type 2 diabetes (T2D) is associated with increased hip fracture risk. We evaluated the impact of T2D on post-hip fracture outcomes, which is less well described. MATERIALS AND METHODS: Individuals aged ≥ 60 years hospitalised for hip fractures between 2011 and 2020 were identified from the territory-wide electronic health records of Hong Kong and stratified by their diabetes status at the time of hip fractures. Individuals were followed up from day of admission to outcomes, death, or December 2023, whichever was earlier. Outcomes included in-hospital complications, in-hospital and 1-year mortality, length of hospitalisation, costs, anti-osteoporosis treatment rate and recurrent fractures. Multivariable regression analyses were performed to identify the independent associations between diabetes and various outcomes. We further analysed the subgroup with undiagnosed diabetes for its impact on post-hip fracture outcomes. RESULTS: We identified 52 472 individuals who sustained hip fractures (34.6% had pre-existing diabetes). T2D was independently associated with more cardiovascular, kidney and infective complications during hospitalisation (all p < 0.001), and higher 1-year mortality (adjusted HR 1.08, 95% CI 1.04-1.13). While in-hospital mortality and length of stay were not significantly different, hospitalisation costs were 4.6% higher in T2D (p < 0.001). Individuals with undiagnosed diabetes showed even higher risks of in-hospital complications and mortality, along with 24.5% higher costs (p < 0.001). T2D did not influence the rate of anti-osteoporosis treatment or recurrent fracture risks. CONCLUSIONS: T2D was associated with worse post-hip fracture outcomes and increased healthcare burdens. Early T2D diagnosis and management, coupled with early attention to bone fragility in T2D, is warranted.