Hip fracture risk high in older diabetics

Older people with diabetes are at greater risk of fracturing their hip than older people without diabetes, research hints.

The researchers compared hip fracture rates among 197,412 Ontario residents at least 66 years of age with diabetes to rates among 401,400 non-diabetics of similar age.

Over the course of about 6 years, there were a total of 22,267 hip fractures; 15,547 in women and 6,720 in men.

According to Dr. Lorraine L. Lipscombe, of the Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada, and colleagues, having diabetes significantly increased the risk of hip fracture in both men and women.

People with type 2 diabetes actually have higher bone mineral density (BMD), and therefore healthier bones, than non-diabetics, possibly because they weigh more. "However, they may still be at increased risk for hip fractures," the team warns in a report in the journal Diabetes Care.

The reason that diabetics have an increased risk of fracture despite higher BMD is unclear. It may be that BMD "does not account for all of fracture risk in this population," the authors say.

For example, patients with diabetes may be more apt to fall because they are more likely to have vision problems, nerve damage, or disease of the arteries that supply blood to the brain, "which may increase the risk of fractures," they note.

"In addition, the pattern and mechanism of falls may be different in diabetes," the investigators say. Diabetic nerve damage and neuromuscular impairment may boost the likelihood of fracture by predisposing individuals to more severe falls or falls toward the side, both of which have been associated with higher hip fracture rates.

SOURCE: Diabetes Care April, 2007.