Supplementary Materials for "Degree of Joint Risk Factor Control and Incident Fracture Outcomes in Individuals with Type 2 Diabetes"

Type 2 diabetes is closely associated with skeletal fragility, which increases the risk of fractures. Fracture prevention in individuals with type 2 diabetes is crucial for reducing fracture incidence. This study explores the relationship between joint risk factor control and fracture risk in individuals with type 2 diabetes. Six modifiable risk factors were assessed: body mass index (BMI), physical activity, smoking, alcohol consumption, serum 25-hydroxyvitamin D [25(OH)D], and glycated hemoglobin A_1c (HbA_1c). The findings demonstrated that controlling multiple risk factors significantly reduced fracture risk, with optimal control correlating with a 50% reduction in overall fractures and a 60% reduction in hip fractures. Furthermore, individuals with type 2 diabetes who controlled four or more risk factors experienced fracture risk comparable to that of non-diabetic controls. These results underscore the importance of joint risk factor management in mitigating the excess fracture risk associated with type 2 diabetes.