Albuminuria an important fracture risk predictor in T2D

Albuminuria is an important and independent predictor of hip fractures and major osteoporotic fractures (MOF) in patients with type 2 diabetes (T2D), and the presence of additional metabolic syndrome (MetS)–related traits compounds this fracture risk, particularly in nonobese patients, a population-based retrospective cohort study in Hong Kong has shown.

The study, led by researchers from the University of Hong Kong, included 165,289 patients with T2D (median age, 60.0 years; male, 54.2 percent) identified from the Hospital Authority’s electronic medical record database in 2000–2018. The patients’ median diabetes duration was 1 year. The most common MetS-related trait was hypertension (78.0 percent), followed by obesity (58.2 percent), hypertriglyceridaemia (33.1 percent), albuminuria (26.7 percent), and low HDL-cholesterol levels (12.0 percent). About one-third (34.2 percent) of patients had three MetS-related traits, while 23.6 percent had four. [J Cachexia Sarcopenia Muscle 2026;17:e70215]

The patients were followed until hip fractures or MOF, death, or 31 December 2020 to evaluate the roles and synergistic implications of MetS-related traits on incident fractures, stratified by obesity status.

Albuminuria: Strongest risk factor for hip fractures & MOF

Incident hip fractures occurred in 0.96 percent of participants after a median follow-up of 5.3 years, translating to an incidence rate (IR) of 1.81 per 1,000 person-years (PY). Meanwhile, 2.05 percent of participants developed MOF over a median follow-up of 5.2 years, translating to an IR of 3.72 per 1,000 PY. The median time to hip fractures and MOF was 4.0 and 3.8 years, respectively.

Albuminuria was the strongest risk factor for both hip fractures and MOF in both obese and nonobese participants. The adjusted hazard ratio (aHR) for hip fractures was 1.33 (95 percent confidence interval [CI], 1.11–1.60) in obese participants and 1.54 (95 percent CI, 1.33–1.78) in nonobese participants. For MOF, the aHR was 1.13 (95 percent CI, 1.01–1.26) and 1.28 (95 percent CI, 1.15–1.43), respectively.

Of note, albuminuria remained a significant risk factor for incident hip fractures and MOF regardless of diabetes duration. However, suboptimal glycaemic control was consistently associated with increased risk of incident hip fractures (aHR, 1.30; 95 percent CI, 1.12–1.50) and MOF (aHR, 1.20; 95 percent CI, 1.09–1.34) only in participants with diabetes duration ≥5 years.

Hypertension was a significant risk factor in nonobese participants only (aHR for hip fractures, 1.36; 95 percent CI, 1.09–1.69) (aHR for MOF, 1.24; 95 percent CI, 1.07–1.43).

In nonobese participants, each additional MetS-related trait was associated with an aHR of 1.17 (95 percent CI, 1.09–1.26) for hip fractures and 1.10 (95 percent CI, 1.04–1.16) for MOF. The association was, however, less pronounced in obese participants, with an aHR of 1.11 (95 percent CI, 1.004–1.220) for hip factures per additional MetS-related trait, but no significant trend for MOF.

Albuminuria screening for fracture risk stratification in T2D?

“Our findings highlight a potential key role of albuminuria screening for fracture risk stratification upon diagnosis of diabetes, akin to albuminuria screening for heart failure or kidney risk stratification in individuals with T2D,” wrote the researchers.