Association between Visit-to-Visit Fasting Plasma Glucose Variability and Osteoporotic Fractures in Nondiabetic Subjects

Jung A. Kim, Ji Sung Lee, Eyun Song, Eun Roh, Ji Hee Yu, Nam Hoon Kim, Hye Jin Yoo, Ji A Seo, Sin Gon Kim, Nan Hee Kim, Sei Hyun Baik, Kyung Mook Choi

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Context: Although long-term glucose variability has been reported to be a risk factor associated with osteoporosis, there have been no previous studies between the relationship of glucose variability and fractures in people without diabetes. Objective: We assessed visit-to-visit variations in fasting plasma glucose (FPG) as a prognostic factor in predicting osteoporotic fractures in individuals without diabetes. Methods: Using a nationwide cohort database, we examined the impact of FPG on the development of osteoporotic fractures in men and women (aged ≥50 years). The primary outcomes were the number of total fractures and vertebral fractures. FPG variability was measured using standard deviation (FPG-SD), coefficient of variation (FPG-CV), and variability independent of the mean (FPG-VIM). Results: Of the 92 929 participants, 5262 (5.7%) developed osteoporotic fractures during the mean follow-up of 8.4 years. Individuals in the highest quartile of FPG-SD showed an 11% and 16% increase in risk of total and vertebral fractures, respectively, compared with those in the lowest quartile after adjustment for mean FPG and other risk factors. Analyses using FPG-CV and FPG-VIM demonstrated similar results. Subgroup analyses and sensitivity analyses to explore potential heterogeneity showed consistent results. Conclusion: FPG variability may be a novel risk factor for osteoporotic fractures independent of risk factors in the general population without diabetes.

Original languageEnglish
Pages (from-to)E3449-E3460
JournalJournal of Clinical Endocrinology and Metabolism
Issue number9
Publication statusPublished - 2021 Sept 1

Bibliographical note

Funding Information:
This work was supported by the Korea University Research Fund (K2100331).

Publisher Copyright:
© 2021 The Author(s). Published by Oxford University Press on behalf of the Endocrine Society. All rights reserved.


  • Fasting plasma glucose variability
  • fracture
  • osteoporosis

ASJC Scopus subject areas

  • Endocrinology, Diabetes and Metabolism
  • Biochemistry
  • Endocrinology
  • Clinical Biochemistry
  • Biochemistry, medical


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