Why Type 2 Diabetes Increases Fracture Risk in Women

Poor physical function, not bone density problems, increases the risk of fractures in older women with type 2 diabetes, a new Swedish study has found.

Diabetes affects over 500 million people worldwide and its prevalence is expected to increase. Only 4% of these people have type 1 diabetes, while the remaining 96% have type 2 diabetes. The disease causes systemic damage to many organs, including kidney failure, cardiovascular disease, retinopathy, neuropathy, and decreased physical activity. And ultimately, a decrease in quality of life.

Type 2 diabetes is also associated with an increased risk of fractures. The risk varies depending on the duration and treatment of the disease. Possible reasons for this association include the accumulation of advanced glycation end products (AGEs) that impair bone strength, decreased bone turnover, and changes in epigenetic markers.

In the study prospective assessment of bone fracture risk A total of 3,008 women aged 75 to 80 years took part in the study at Sahlgrenska University Hospital. Data were collected using questionnaires, anthropometry, physical function assessment, bone mineral density measurements using dual-energy X-ray (DEXA) and advanced computed tomography (CT).

The researchers took into account clinical risk factors such as smoking, use of glucocorticosteroids (steroid hormones), the presence (or not) of rheumatoid arthritis, alcohol use, and previous fractures in the patient or a parent.

“Previous studies have lacked access to comprehensive and detailed data on bone characteristics and physical function, making it difficult to identify factors that increase fracture risk,” said lead study author Mathias Lorentzon, professor of geriatric medicine at the University of Gothenburg School of Medicine and chief physician at the Osteoporosis Clinic at Sahlgrenska University Hospital, Mölndal, Sweden.

To examine the role of bone mineral density in fractures in women aged 75 to 80 years with type 2 diabetes, the researchers analyzed data from 294 people with type 2 diabetes and 2,714 women without diabetes. The researchers then collected data on the participants' physical activity, bone density and quality.

Women with type 2 diabetes had, on average, a higher body mass index than the control group. The study also found that women with type 2 diabetes had 4.4% higher bone mineral density at the hip. A similar increase was seen in the femoral neck and lumbar spine.

Participants with type 2 diabetes also had a physical activity score that was 19.2% lower than participants without diabetes.

The researchers noticed that Women taking type 2 diabetes medications had higher bone densitygreater strength and better microarchitecture of bone tissue. But – lower physical performance compared to the control group. It was also found that in women receiving insulin therapy, the risk of fractures increases by 71%, and in women taking oral therapy, the risk of fractures is higher by 27%.

“Type 2 diabetes often leads to increased bone density, but also a higher risk of fractures. This is because bone quality is compromised by factors such as high blood sugar and chronic inflammation,” explained pathologist Joshua Quinones, who was not involved in the study.People with type 2 diabetes are more likely to break bones because their bones are denser and weaker.“High blood sugar and inflammation can damage bones, and diabetes can also affect balance when walking and vision, leading to more falls,” he added. Increased fracture risk is associated with increased risk of pain and disability, as well as decreased quality of lifewhich can impact overall health. The expert explained that one way to combat this problem is to improve physical function/activity. “We are interested in finding out whether improving physical function can reduce the risk of fractures in these patients,” he concluded.

The results of the study were published in the scientific journal JAMA.

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