Obstructive Sleep Apnoea and Risk of Fragility Fracture in Patients With Type 2 Diabetes: A Population-Based Retrospective Cohort Study.

OBJECTIVE: This study examines the risk of fragility fractures in patients with type 2 diabetes (T2D) who have obstructive sleep apnoea (OSA) compared to those without OSA. METHOD: This retrospective cohort study uses UK primary care data from 2000 to 2022. T2D patients without prior fragility fractures were included. Patients with OSA were matched with up to 4 non-OSA patients based on age, sex, BMI and T2D duration. Two cohorts were analysed based on whether OSA was diagnosed before (cohort 1) or after (cohort 2) the T2D diagnosis. Hazard ratios were calculated using a Cox proportional hazards model. RESULTS: Cohort 1 included 19,795 patients with OSA and 64,124 without OSA. Cohort 2 included 21,769 patients with OSA and 66,350 without OSA. OSA was associated with an increased risk of incident fragility fractures in both cohorts [aHR (95% CI): 1.12 (1.00-1.25); p = 0.04, and 1.15 (1.05-1.26; p = 0.002), respectively]. The point estimates of the subgroup analysis by age and gender of cohort 1 suggest an association between OSA and the risk of fractures in men and in those above 50 years old. In cohort 2, the subgroup analysis point estimate suggests an association between OSA and fragility fractures in men and women and those above and below 50 years old. CONCLUSION: OSA is associated with an increased fragility fracture risk in T2D patients. Further studies are needed to determine if treating OSA reduces this risk. Clinicians should consider bone health and fracture risk, particularly for older patients.