Poor glycaemic control tied to raised fracture risk

Those with vascular complications such as retinopathy face an even higher risk: study

Patients with type 1 diabetes are more likely to break a bone when they have poor glycaemic control, a large study suggests.

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Diabetes has long been linked to an increased risk of fractures, but research to date has been mixed regarding exactly what role blood glucose levels play in this risk, the Swiss authors say.

Researchers at University Hospital Basel looked at almost 3330 individuals with type 1 diabetes and 44,275 with type 2 diabetes diagnosed between 1995 and 2015 in the UK.

During the study period, 672 people with type 1 diabetes and 8859 with type 2 diabetes experienced bone fractures.

Median duration between diabetes onset and fracture date was 4.5 years for both groups.

The risk of fracture was increased in type 1 diabetes patients with mean HbA1c greater than 8.0% (adjusted odds ratio: 1.39) compared with their peers with mean HbA1c values of 7.0% or less.

Blood glucose levels didn't appear to influence the risk of fractures for patients with type 2 diabetes, according to the study in the Journal of Clinical Endocrinology and Metabolism.

Several complications of diabetes, including cognitive impairment, neuropathy and retinopathy, might contribute to an increased risk of falls and fractures.

Among patients in the study with type 1 diabetes patients, those with vascular complications such as retinopathy were 29% more likely to experience fractures than people who didn't have these complications.

Vascular complications did not appear to influence fracture risk for people with type 2 diabetes.

One limitation of the study was that the researchers didn't account for whether patients had diabetic neuropathy, said Dr James Richardson, a professor in physical medicine in rehabilitation at Michigan Medicine in Ann Arbor, Michegan, US, who wasn't involved in the research.

That factor might explain a lot of the accidents leading to bone fractures, he said.

"Fall risk is markedly increased in people who cannot successfully respond to a postural perturbation (such as a trip or slip, ankle turn) in the roughly 400 milliseconds available to do so," he said.

More information: Journal of Clinical Endocrinology and Metabolism 2019.