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THU0334 Severity of Diabetes Mellitus and Risk of Total Hip or Knee Replacement: A Population Based Case-Control Study
  1. J.T.H. Nielen1,2,
  2. B. van den Bemt3,4,
  3. A. Lalmohamed2,5,
  4. A. de Boer2,
  5. A. Boonen6,
  6. P.C. Dagnelie1,
  7. P. Emans7,
  8. F. de Vries2,8
  1. 1Department of Epidemiology, Maastricht University, Maastricht
  2. 2Division of Pharmacoepidemiology & Clinical Pharmacology, Utrecht University, Utrecht
  3. 3Department of Pharmacy, Radboud University Medical Center
  4. 4Department of Pharmacy, Sint Maartenskliniek, Nijmegen
  5. 5Department of Clinical Pharmacy, University Medical Center Utrecht, Utrecht
  6. 6Department of Rheumatology
  7. 7Department of Orthopaedics
  8. 8Departement of Clinical Pharmacy and Toxicology, Maastricht University Medical Center, Maastricht, Netherlands


Background It is generally thought that people with diabetes mellitus (DM) are more likely to suffer from OA due to an increased Body Mass Index (BMI), resulting in the mechanical destruction of cartilage. However, previous studies have shown that DM could also be an independent risk factor for OA, suggesting other causative factors are involved (Nieves-Plaza M, 2013; Schett G, 2013).

Objectives To evaluate the risk of hip or knee replacement, as a proxy for severe osteoarthritis (OA), in patients with diabetes mellitus (DM) compared to non-diabetic patients. We additionally evaluated the risk of total joint replacement (TJR) with various proxies for increased DM severity.

Methods We performed a population based case-control study using the Clinical Practice Research Datalink (CPRD). Cases (n=94,609) were defined as patients >18 years who had undergone TJR between 2000 and 2012. Controls were matched by age, gender and general practice. Conditional logistic regression was used to estimate the risk of total knee (TKR) and total hip replacement (THR) surgery associated with use of antidiabetic drugs (ADs). We additionally stratified current AD users by proxies for DM severity.

Results Current AD use was significantly associated with a lower risk of TKR (OR=0.86 (95% CI=0.78-0.94)) and THR (OR=0.90 (95% CI=0.82-0.99)) compared to patients not using ADs. Moreover, risk of TKR and THR was decreased with increasing HbA1c.

Conclusions In contrast to previous research, this study does not support the hypothesis that diabetic patients are more likely to suffer from severe OA as compared to non-diabetic patients. This is possibly due to methodological and medical dissimilarities between studies.


  1. Nieves-Plaza M. Journal of Clinical Rheumatology, 2013; Schett G. Diabetes Care, 2013

Disclosure of Interest J. Nielen: None declared, B. van den Bemt Grant/research support from: Pfizer, Roche, Speakers bureau: Pfizer, Roche, Abbvie and MSD, A. Lalmohamed Grant/research support from: Netherlands Organisation for Scientific Research (NWO), A. de Boer: None declared, A. Boonen Grant/research support from: Amgen Abbvie, Pfizer and Merck, Speakers bureau: Pfizer, UCB and Sandoz, P. Dagnelie: None declared, P. Emans Grant/research support from: Stryker, Active implants, Carbylan Biosurgery, DSM Biomedical, Regentis, Speakers bureau: Biomet and Push braces, F. de Vries: None declared

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