Type 2 diabetes (T2D) is reaching epidemic
proportions in many parts of the world. People with diabetes have been
shown to be at higher risk of fracture, with the relative risk of hip
fracture up to seven-fold higher in patients with type 1 diabetes and
approximately 1.3-fold higher in patients with type 2 diabetes.
Nevertheless, most patients with diabetes are never assessed for
osteoporosis and, as shown by recent data, they are less likely to be
prescribed treatment for osteoporosis than persons without diabetes.
‘Understanding of fracture risk in diabetes and identifying future areas of research will help better target patients in need of fracture prevention.’
This is because determining the individual fracture risk of a
patient with diabetes is challenging for the physician as current
fracture predictors - namely, bone mineral density (BMD) and fracture
risk assessment tools, underestimate fracture risk in these patients.
A new review in the journal Calcified Tissue International & Musculoskeletal Research
looks at the complexity of fracture epidemiology in diabetes, and makes
recommendations for the clinician and for future research. It addresses
a major difficulty: the tight connection between the disease itself and
diabetes-related complications, comorbidities and shared risk factors.
'Epidemiology of Fractures in Diabetes' examines current data on the
various risk factors which influence fracture risk in diabetes, such as
age, gender, previous fracture, glucocorticoid-use, smoking and alcohol
use, as well as the potential role of falls, pancreatitis and
The authors identify areas in which further research is needed,
particularly emphasizing the need for epidemiological studies to
disentangle the effects of shared risk factors for diabetes and
fracture, such as pancreatitis and oral glucocorticoid-use. Furthermore,
more research is needed on the effect of falls and hypoglycemia on the
risk of fractures in patients with diabetes.
The review urges that physicians be cognizant of the fact that
current risk factor calculators may not adequately predict fractures in
people with diabetes, and that extra vigilance is therefore required.
Imaging of the spine by vertebral fracture assessment or spine X-ray may
help identify vertebral fractures and predict new fractures.
prevention strategies may also be recommended and in patients with
diabetes this may be achieved by detecting and preventing hypoglycemic
events and orthostatic hypotension due to antihypertensive treatment and
of course by optimum long-term management to reduce the risk of
neuropathy and retinopathy.
Professor Bo Abrahamsen, Dept. of Medicine, Holbaek Hospital,
Holbaek, Denmark, stated, "Given that the global burden of both diabetes
(currently 400 million people) and osteoporosis (currently 250 million)
is expected to increase dramatically in the coming years, it is
important that effective screening and prevention strategies are
developed to reduce the risk of potentially devastating fractures in
people with diabetes."