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Poor physical function appeared to be the primary reason for increased fracture risk in older women with type 2 diabetes, a prospective observational study suggested.

According to Mattias Lorentzon, MD, PhD, of Sahlgrenska University Hospital in Mölndal, Sweden, and colleagues, older women with type 2 diabetes versus those without had:

• 9.7% lower grip strength (13.5 vs 14.9 kg)
• 9.9% slower gait speed (1.15 vs 1.27 m/s)
• 13.9% slower timed up-and-go time (9.1 vs 7.9 seconds)
• 27.2% fewer seconds for the one leg standing balance test (10.8 vs 14.2 seconds)
• 17.3% fewer rises on the 30-second chair stand test (9.0 vs 10.7)

During a median follow-up of 7.3 years, 1,071 incident fractures, 853 major osteoporotic fractures, and 232 hip fractures occurred. In Cox regression models adjusted for age, BMI, clinical risk factors, and femoral neck bone mineral density, type 2 diabetes was associated with an increased risk of any fracture (HR 1.26, 95% CI 1.04-1.54) and major osteoporotic fractures (HR 1.25, 95% CI 1.00-1.56), they wrote in.

"Type 2 diabetes is known to increase the risk of bone fractures, but if this is due to affected skeletal characteristics or due to poor physical function, resulting in falls, has been insufficiently investigated," Lorentzon told 番茄社区. "This is of importance for healthcare providers when instituting measures to avoid fractures -- should the focus be on preventing falls or treating osteoporosis?"

"We expected that patients with type 2 diabetes would have a worse physical function, but the large magnitude of the difference was a bit of a surprise," he noted, adding that his group was also surprised to find that most skeletal characteristics, including bone microstructure, density, and geometry, were better in patients with type 2 diabetes than in those without.

"Previous studies have found worse bone material properties in those with type 2 diabetes, but this study did not observe any difference in that trait," he said.

In this study, the participants with type 2 diabetes had significantly higher bone mineral density at several sites versus those who did not:

• 4.4% higher at total hip (0.84 g/cm² vs 0.80 g/cm²)
• 4.9% higher at femoral neck (0.69 g/cm² vs 0.66 g/cm²)
• 5.2% higher at lumbar spine (0.99 g/cm² vs 0.94 g/cm²)

At the ultradistal tibia, women with diabetes had 7.4% greater cortical area, 1.3% greater density, and 8.7% higher trabecular bone volume fraction than women without diabetes.

There was no difference in bone material strength index in the subsample of women who underwent bone microindentation (mean 78.0 for those with type 2 diabetes vs 78.1 for those without).

Based on the study's findings, Lorentzon said preventive measures for falls and restoring physical function are important risk mitigation strategies in this patient population. While there wasn't a difference in prior fall prevalence, the researchers said the reliability of self-reported previous falls is low and may not accurately identify individuals at risk.

For this study, Lorentzon and team used data from the population-based Sahlgrenska University Hospital Prospective Evaluation of Risk of Bone Fractures study cohort of older women, conducted in the Gothenburg area from March 2013 to May 2016. Follow-up of incident fractures was completed in March 2023.

They included 3,008 participants ages 75 to 80, 294 of whom had type 2 diabetes, while the rest did not. Mean age for both groups was 77.8. Women with type 1 diabetes were excluded.

When stratified by diabetes treatment type, those on insulin had the highest risk for any fracture (HR 1.71, 95% CI 1.16-2.54) followed by those on an oral medication (HR 1.27, 95% CI 1.00-1.62). Additionally, risk for fracture and diabetes duration increased hand-in-hand, in line with a .

The researchers noted that their findings can't be generalized to other groups outside of older women.

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