Poor physical function may lead to higher fracture risk for women with type 2 diabetes
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Key takeaways:
- Older women with type 2 diabetes have higher BMD than those without diabetes.
- Worse physical function scores were observed in the type 2 diabetes group.
- Fractures are more common among those with type 2 diabetes.
Worse physical function may be the factor contributing to an increased fracture risk for women aged 75 to 80 years with type 2 diabetes, according to a study published in JAMA Network Open.
Researchers assessed bone measurements and results from multiple physical function tests in a group of women with type 2 diabetes and compared the results to a group without diabetes. Women with type 2 diabetes had higher risk for incident fractures than those without diabetes. The type 2 diabetes group had higher bone mineral density than the group without diabetes, but performance in physical functioning tests was worse for the diabetes group.
“[Worse physical function] could be the principal reason for the increased fracture risk observed in this study among older women with type 2 diabetes,” Mattias Lorentzon, MD, PhD, professor and chief physician in the Institute of Medicine at the University of Gothenburg and chief physician at the osteoporosis clinic at Sahlgrenska University Hospital in Sweden, and colleagues wrote.
Lorentzon and colleagues collected data from 3,008 women aged 75 to 80 years who participated in a prospective cohort study conducted in Sweden (mean age, 77.8 years). The study group included 294 women with type 2 diabetes and 2,714 women without diabetes. DXA scans were performed to measure areal BMD. Trabecular bone score was obtained using the mean score of the L1 to L4 vertebrae. High-resolution peripheral quantitative CT was used to measure bone microarchitecture at the nondominant radius and ipsilateral tibia. Participants completed the one leg standing test, the timed up-and-go test to measure functional mobility, the 30-second chair stand test, a grip strength test and a 10 m walking test. Incident fractures were collected from baseline until March 2023. Fractures were categorized as major osteoporotic fractures, any fracture or hip fracture.
During a median 7.3 years, there were 1,071 incident fractures, 853 major osteoporotic fractures and 232 hip fractures. Women with type 2 diabetes were more likely to have any fracture (adjusted HR = 1.26; 95% CI, 1.04-1.54) and a major osteoporotic fracture (aHR = 1.25; 95% CI, 1-1.56) than women without diabetes.
Higher BMD in type 2 diabetes
Women with type 2 diabetes had a 4.4% higher total hip BMD, a 4.9% higher femoral neck BMD and a 5.2% higher lumbar spine BMD than those without diabetes. Trabecular bone score was 1.6% lower for women with diabetes than those without diabetes. Bone material strength index was similar between the two groups.
The type 2 diabetes group had a 7.4% greater cortical area, 8.4% higher total volumetric BMD, 1.3% greater cortical volumetric BMD, 8.7% higher trabecular bone volume fraction, 2.9% higher trabecular thickness and 6.8% lower trabecular separation than women without diabetes. Women with type 2 diabetes had greater stiffness and ultimate failure load than the nondiabetes group.
On physical function tests, the type 2 diabetes group had an 27.2% shorter one leg stand test, 13.9% longer time on the up-and-go test, 9.9% slower walking speed, 17.3% fewer rises on the 30-second chair stand test and 9.7% less grip strength than those without diabetes.
“The results from the present study and previous evidence demonstrate that physical activity is lower, and physical performance is impaired in type 2 diabetes, and it is clear that poor physical performance is independently associated with fracture risk,” the researchers wrote. “It was therefore hypothesized that reduced physical performance, and not impaired bone health, is the underlying reason for the increased risk of fracture observed in type 2 diabetes.”
Diabetes drugs tied to higher fracture risk
In subgroup analysis, women with type 2 diabetes using insulin had higher risks for any fracture (aHR = 1.71; 95% CI, 1.16-2.54) and major osteoporotic fractures (aHR = 1.89; 95% CI, 1.24-2.87) than women without diabetes. Those receiving oral type 2 diabetes medication also had higher risk for any fracture (aHR = 1.27; 95% CI, 1-1.62).
In a sensitivity analysis, women with type 2 diabetes who sustained a fracture had higher areal BMD at the total hip and lumbar spine and higher ultradistal failure load and stiffness as those without diabetes who sustained a fracture. Those in the type 2 diabetes group who had a fracture performed worse on all five physical function tests than women without diabetes who had a fracture.
The researchers cautioned that the participants were women aged 75 to 80 years and the results may differ in another population. Additionally, they wrote that causality cannot be determined due to the nature of the study.
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