Risk for falls, fractures rises with diabetes
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Adults with diabetes are at greater risk for experiencing traumatic fall events leading to fractures compared with healthy controls; identifying modifiable risk factors, such as medication use, may improve patient outcomes, data show.
“There is a well-established increased risk for fractures among people with diabetes, mainly because of changes in bone structure; however, that does not seem to tell the whole story or explain the increased fracture burden,” Nicklas Højgaard-Hessellund Rasmussen, MD, a doctoral student in the department of endocrinology at Aalborg University Hospital and the Steno Diabetes Center North Jutland, Denmark, told Healio. “We wanted to investigate at which point falling could also be increased in people with diabetes, hence contribute to the fracture burden.”
Rasmussen and colleagues analyzed data from adults with type 1 diabetes (n = 12,975) and type 2 diabetes (n = 407,009), stratified by diabetes type and matched 1:1 by age and sex with healthy controls, using data from the Danish National Patient Register.
Researchers used a Cox proportional hazards model to assess all episodes of adults hospitalized with a first fall from 1996 to 2017. Risk factors such as age, sex, diabetes complications, alcohol use and medication history were included in an adjusted analysis. The data were presented at the European Association for the Study of Diabetes Annual Meeting.
The cumulative incidence of falls requiring hospital treatment was 13.3% for adults with type 1 diabetes and 11.9% for adults with type 2 diabetes. In adjusted analyses, type 1 diabetes was associated with a 33% higher risk for falls (HR = 1.33; 95% CI, 1.25-1.43) and type 2 diabetes was associated with a 19% higher risk for falls (HR = 1.19; 95% CI, 1.16-1.22).
In sensitivity analyses, fall risk was higher for both diabetes groups vs. controls among women, those aged at least 65 years, those prescribed selective serotonin receptor inhibitors or opioids, and those with a history of alcohol use disorder.
Compared with controls, the incidence rate ratio (IRR) of fall-related injuries was higher for adults with type 2 diabetes at the hip (IRR = 1.02; 95% CI, 1.01-1.04), radius (IRR = 1.39; 95% CI, 1.18-1.61), humerus (IRR = 1.24; 95% CI, 1.12-1.37) and skull/face (IRR = 1.15; 95% CI, 1.07-1.24). Among adults with type 1 diabetes, IRR of fall-related injuries was higher only for hip fractures compared with controls (IRR = 1.11; 95% CI, 1.11-1.23).
“People with diabetes are more likely to experience falls and fractures,” Rasmussen said. “Each are tremendous burdens for the individual, but also have a socioeconomic impact. Management and identification of risk factors for falls and fractures are important to improve quality of life and reduce the cost to society.”
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Rasmussen NH, et al. Abstract #279. Presented at: EASD Annual Meeting; Sept. 21-25, 2020 (virtual meeting).
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