Background. Diabetes seems to be associated with an increased risk of fractures in the general population. We aimed to determine whether pre-transplant diabetes increases the risk of fractures among patients receiving solid organ transplantation. / Methods. We conducted a nested case-control study in a cohort of subjects 18 years and older who received a first solid organ transplantation in Quebec between January 1st 1986 and July 31st 2005, and who were covered by the RAMQ drug plan at least 1 year before the transplantation and 3 months after the date of discharge from the transplantation hospitalization. Cases were subjects from the cohort who had sustained a fracture between the date of discharge from the hospitalization for transplantation and the end of the study period or the patient's death. The fracture date was the case index date. All incidental fractures were included except fractures of the skull, phalanges of the hand and foot, multiple fractures and pathological fractures, and were identified by medical service claims. Controls were matched to cases on the type of organ transplanted and on the date of the transplantation (+/- 3 months). Crude and adjusted odds ratios (OR) were obtained with univariate and multivariate conditional logistic regression models. / Results. The study included 238 cases and 873 controls. Pre-transplant diabetes was present in 30% of the cases and 22% of the controls (crude OR: 2.16, 95% CI: 1.7--2.8). After adjusting for potential confounders, pre-transplantation diabetes remained a significant risk factor for fractures (adjusted OR: 1.94, 95% CI: 1.5--2.6). / Conclusion. Pre-transplant diabetes appeared to significantly increase post-transplant fractures among adults receiving solid organ transplantation.

Objectives. beta-blockers can alter bone turnover and increase bone formation in animals. It is unknown whether beta-blockers have similar bone protective effects in humans. We aimed to estimate the effects of beta-blockers on bone mineral density (BMD) and fractures using data from the Canadian Multicentre Osteoporosis Study, a large prospective cohort study. / Methods. All medications, including beta-blockers, taken at baseline and after five years of follow-up were recorded. BMD was measured at baseline. During the five years of follow-up, incident minimal trauma fractures were documented by yearly questionnaires. To compare users of beta-blockers to non-users while controlling for possible confounders, multiple linear regression was utilized to estimate between group differences in BMD and multivariate logistic regression was employed to estimate differences in fracture risk. / Results. Of the 9423 participants, 236 of 2884 males (8.2%) and 600 of 6539 females (9.2%) used beta-blockers at some point during the study. In men, beta-blocker users had differences of +1.1% (95% confidence interval [CI] -0.9%, 3.0%) and +1.2% (95% CI -0.5%, 4.0%) in baseline BMD at the total hip and at the lumbar spine, respectively, compared to non-users. In women, beta-blocker users had differences of +0.05% (95% CI -1.2%, 1.3%) and +0.2% (95% CI -1.3%, 1.7%) for the BMD of the total hip and the lumbar spine, respectively, compared to non-users. For users of beta-blockers at baseline, the adjusted odds ratio (OR) for any minimal trauma fracture was 1.23 (95% CI 0.67--2.25) in men and 1.02 (95% CI 0.76--1.35) in women. Chronic use (user at baseline and year 5) in men had an OR for any minimal trauma fracture of 2.1 (95% CI 1.0--4.3). In women who used beta-blockers at baseline but not at year 5, the OR for hip fracture was 6.3 (95% CI 2.0--19.3). The risk of fractures for other sites was inconclusive owing to wide confidence intervals. / Conclusion. Despite relatively large numbers of subjects, wide confidence intervals do not permit strong conclusions with regards to the effect of beta-blockers on BMD in men. Using a 2% limit of clinical importance for BMD, there appears to be no effect of beta-blockers on BMD in women. There is some evidence from our study that beta-blockers may be associated with an increased risk of fractures in certain subsets of users.

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