Published research has indicated that people with type 2 diabetes are at increased risk for bone fractures. The link between diabetes and fracture risk, however, has historically depended upon the location of the fracture being investigated. Few large, community-based studies of fracture risk have explored possible associations of diagnosed diabetes, undiagnosed diabetes, and fracture risk.

“The risk of fracture-related hospitalizations was higher among adults with diagnosed diabetes than those without the disease.”

In an effort to fill the void in available research, my colleagues and I conducted a study that compared the risk of fracture-related hospitalization in people without diabetes to those with diagnosed and undiagnosed diabetes. We also examined associations of diabetes medication use and chronic hyperglycemia with fracture risk. Our study—published in Diabetes Care—used data from the NIH-funded Atherosclerosis Risk in Communities Study, a community-based population.

Diabetes Increases Risks

Results from our investigation showed that the risk of fracture-related hospitalizations was higher among adults with diagnosed diabetes than those without the disease. The risk of fracture-related hospitalization was nearly twice as high for people with diagnosed diabetes. These findings remained even after adjusting for important risk factors, such as age, sex, BMI, physical activity, and smoking. Conversely, fracture risk was similar between people with undiagnosed diabetes and those without the disease.

Diabetes-Fracture-Callout

Importantly, our analysis also revealed that fracture risk was higher in people with diagnosed diabetes who were treated with insulin. The risk was also higher in those with A1C levels of 8% or higher when compared with those who had A1Cs lower than 8%. The associations of diagnosed diabetes and fracture risk did not differ by age, race, sex, or menopausal status (among women).

Assessments Matter

When taken as a whole, it appears that the mechanisms linking diabetes and fracture risk may be related to diabetes severity, glycemic control, and/or the use of insulin to treat diabetes. Our results support recommendations from the American Diabetes Association that encourage clinicians to assess fracture risk and implement both primary and secondary prevention strategies for diabetes and to reduce fall risks. Patients with poor glycemic control may particularly benefit from aggressive fracture-prevention efforts.

Fall prevention efforts using strength and aerobic exercise programs may be of benefit and should combine strength, balance, flexibility, and/or endurance. Future studies should seek to better understand if specific strategies to improve glycemic control and minimize hypoglycemic episodes could help prevent fractures in people with diabetes.

References

Schneider ALC, Williams EK, Brancati FL, Blecker S, Coresh J. Selvin E. Diabetes and risk of fracture-related hospitalization: the Atherosclerosis Risk in Communities Study. Diabetes Care. 2012 Dec 17 [Epub ahead of print]. Available at: http://care.diabetesjournals.org/content/early/2012/12/14/dc12-1168.full.pdf+html.

American Diabetes Association. Standards of Medical Care in Diabetes–2013. Diabetes Care. 2013;36:S1-S110.

Moseley KF. Type 2 diabetes and bone fractures. Curr Opin Endocrinol Diabetes Obes. 2012;19:128-135.

Schwartz AV, Margolis KL, Sellmeyer DE, et al. Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial. Diabetes Care. 2012;35:1525-1531.

Melton LJ 3rd, Leibson CL, Achenbach SJ, Therneau TM, Khosla S. Fracture risk in type 2 diabetes: update of a population-based study. J Bone Miner Res. 2008;23:1334-1342.

Yamamoto M, Yamaguchi T, Yamauchi M, Kaji H, Sugimoto T. Diabetic patients have an increased risk of vertebral fractures independent of BMD or diabetic complications. J Bone Miner Res. 2009;24:702-709.

Gordon BA, Benson AC, Bird SR, Fraser SF. Resistance training improves metabolic health in type 2 diabetes: a systematic review. Diabetes Res Clin Pract. 2009;83:157-175.