Untangle Complexities of Diabetes, Fracture!

To add to our knowledge base about the scourge of diabetes, researchers from Denmark have gathered new data on the risk factors that influence fracture risk in diabetic patients. A new review article in Calcified Tissue International & Musculoskeletal Research examines the complexity of fracture epidemiology in diabetes. As indicated in the October 17, 2016 news release, “It addresses a major difficulty: the tight connection between the disease itself and diabetes-related complications, comorbidities and shared risk factors.”

“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 hypoglycaemia on the risk of fractures in patients with diabetes.”

Professor Bo Abrahamsen, Ph.D. is with the Department of Medicine at Holbaek Hospital in Denmark. He told OTW, ”Patients with diabetes and in particular long standing disease are at higher risk of falls and fractures. In the emergency room it is helpful to know that patients with diabetes are much more likely to suffer fractures from seemingly trivial trauma and that patients with diabetes are often not on medical treatment for osteoporosis. Vertebral fractures are very common in type I and to a lesser degree in type II diabetes but often overlooked. Hip fracture risk is increased in both types of diabetes. I believe the threshold for diagnostic imaging for fractures and osteoporosis should be much lower in patients with diabetes than what most doctors recognize.”

“On a positive note, there is a lot we can do prevent fractures in diabetes once we know that a person has osteoporosis. From a best practice standpoint it is important to recognize that patients with diabetes have a lower fracture threshold and there is a higher risk of overlooking fractures if one is not aware of this. Vertebral fractures appear to be particularly often missed in type 1 diabetes.”

“The recent Canadian Multicentre Osteoporosis Study (CaMos) revealed that not only did patients with diabetes have more fractures, they were also significantly less likely to receive medical treatment for osteoporosis. This is probably in part because bone mineral density in type 2 diabetes often isn’t reduced to a degree that would cause fractures in others and some patients will have reduced renal function to a degree that precludes treatment with bisphosphonates but it still suggests we are not doing a great job when it comes to preventing fractures in diabetes.”