More Research Needed to Understand Link Between Diabetes, Fractures

Researchers say more work is needed to create calculators that predict fracture risk in individual patients with diabetes.

More diabetes, more obesity, and an aging population have added up to an increased risk for hip fractures, yet little is being done to find out which patients face this risk or even study the problem, according to a new review article.

A report in the journal Calcified Tissue International & Musculoskeletal Research examined the epidemiology of fractures in diabetes, and made recommendations for today’s doctors and for future studies. People with type 2 diabetes are 1.3 times more likely to have a hip fracture, and the risk is 7 times greater for those with type 1 diabetes.

But despite this, most doctors treating patients with diabetes never assess an individual patient for fracture with a bone mineral density test, according to the authors. The authors of the article, “Epidemiology of Fractures in Diabetes,” looks at current data on various risk factors that influence fracture risk, including age, gender, fracture history, smoking and alcohol use, risk of falls, glucocorticoid steroid use, pancreatitis, and autoimmune disease.

The authors say more work is needed to better understand the links between fractures and diabtes, and especially to develop better risk calculators for fracture. Current tools may not accurately predict which individual patients with diabetes will experience them. Spine imaging may help, and fall prevention strategies may be recommended for patients. The best course is good long-term management of the disease itself, which prevents hypoglycemic events and reduces the risk of neuropathy and retinopathy.

“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,” said the paper’s senior author, Professor Bo Abrahamsen, of the Department of Medicine, Holbaek Hospital, in Denmark.


Starup-Linde J, Frost M, Vestergaard P, Abrahamsen B, Epidemiology of fractures in diabetes [published October 17, 2016]. Calcif Tissue Int. 2016; doi:10.1007/s00223-016-0175-x.

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