RISK FACTORS OF LOW-ENERGY FRACTURES IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Osteoporosis is a metabolic disease of the bone tissue, which is characterized by a violation of the qualitative (microarchitecture change) and quantitative characteristics (decreased bone mass) of the skeleton, and, as a result, lowenergy fractures. The medical and social significance of osteoporosis is due to its consequences: fractures of the femoral neck, vertebral bodies, radius and other large bones of the skeleton, which significantly reduces the quality of patients’ lives and entails significant financial costs for treatment and rehabilitation. Prevalence of diabetes mellitus (DM) significantly increases in all countries of the world, including the Russian Federation. Diabetes and osteoporosis were considered to be individual diseases for a long time. In many prospective large-scale studies it was proved that patients with T2DM have a greater risk of falls and fractures in contrast with the overall population. Despite the increased risk of fractures in diabetic patients, there is still no risk stratification in these patients. The link between the classic risk factors of osteoporotic fractures (such as chronic intake of glucocorticoids, use of alcohol, tobacco, etc.) and the occurrence of fractures is similar in patients with both T2DM and without it. However, it is necessary to take into account other characteristics of diabetes. The specific risk factors of fractures in T2DM patients are duration of the diabetes for more than 10 years, diabetes decompensation, the severity of diabetes, obesity, the frequency of falls, hypoglycemia, insulin, thiazolidinedione, exenatide, sulfonylureas, canagliflozin therapy, and, most likely, the reduction of 25 (OH) vitamin D, functional hypoparathyroidism, the increase of sclerostin, pentosidine, decreased bone mineral density (BMD) of the hip.

Download Full-text

Effect of Antidiabetic Treatment on Bone

Physiological Research ◽

10.33549/physiolres.934297 ◽

2019 ◽

pp. S107-S120 ◽

Cited By ~ 1

Author(s):

J. JACKULIAK ◽

M. KUŽMA ◽

J. PAYER

Keyword(s):

Diabetes Mellitus ◽

Bone Fractures ◽

Negative Impact ◽

Osteoporotic Fractures ◽

Antidiabetic Drugs ◽

Mineral Density ◽

Skeletal Health ◽

Antidiabetic Treatment ◽

Increased Risk ◽

Patients With Diabetes

Patients with diabetes mellitus are at an increased risk of bone fractures. Several groups of effective antidiabetic drugs are available, which are very often given in combination. The effects of these medications on bone metabolism and fracture risk must not be neglected. Commonly used antidiabetic drugs might have a positive, neutral or negative impact on skeletal health. Increased risk of fracture has been identified with use of thiazolidinediones, most definitively in women. Also treatment with sulfonylureas can have adverse effects on bone. One consequence of these findings has been greater attention to fracture outcomes in trails of new diabetes medication (incretins and SGLT-2 inhibitors). The effect of insulin on bone is discussed and the risk of fractures in patients using insulin seems to be unrelated to insulin as itself. The aim of the review is to summarize effects of antidiabetic treatment on bone – bone mineral density, fractures and bone turnover markers. The authors also try to recommend a strategy how to treat patients with diabetes mellitus regarding the risk of osteoporotic fractures. In this review the problem of how to treat osteoporosis in patient with diabetes is also discussed.

Download Full-text

Pathogenetic aspects of bone metabolism in diabetes mellitus.

Clinical Medicine (Russian Journal) ◽

10.18821/0023-2149-2018-96-8-707-712 ◽

2018 ◽

Vol 96 (8) ◽

pp. 707-712

Author(s):

S. S. Safarova

Keyword(s):

Diabetes Mellitus ◽

Bone Tissue ◽

Molecular Mechanisms ◽

Bone Structure ◽

Advanced Glycation Endproducts ◽

Fatty Infiltration ◽

Osteoporotic Fractures ◽

Inflammatory Factors ◽

Mineral Density ◽

Increased Risk

Metabolic disorders caused by diabetes affect bone remodeling, alter the structure and reduce the strength of bone tissue, leading to the development of diabetic osteopathy. However, between diabetes mellitus (DM) type 1 and 2 there are noticeable differences in the effect on the bone structure, which is obviously due to the different cellular and molecular mechanisms of these processes. The density of bone tissue with DM typel decreases, which leads to an increase in the risk of fractures by 7 times. With DM type 2, bone mineral density is moderately elevated, which is expected to lead to a decrease in the incidence of osteoporotic fractures, but in fact, this index is approximately doubled. Pathophysiological mechanisms underlying osteoporotic changes in diabetes mellitus are complex and included hyperglycemia, oxidative stress and accumulation of advanced glycation endproducts that alter the properties of collagen, increase fatty infiltration of the bone marrow, release inflammatory factors and adipokines from visceral adipose tissue and potentially change the function osteoblasts. Additional factors are, some antidiabetic drugs that directly affect the metabolism of bones and minerals (such as thiazolidinediones), as well as an increased tendency to fall due to micro- and macroangiopathies, all contribute to an increased risk of low-fracture fractures in patients with diabetes mellitus.

Download Full-text

Increased Rates of Readmission, Reoperation, and Mortality Following Open Reduction and Internal Fixation of Ankle Fractures Are Associated with Diabetes Mellitus

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00324 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0032

Author(s):

Jennifer Liu ◽

Junho Ahn ◽

Dane Wukich ◽

Katherine Raspovic

Keyword(s):

Diabetes Mellitus ◽

Internal Fixation ◽

Ankle Fracture ◽

Open Reduction ◽

Large Scale ◽

Ankle Fractures ◽

Unplanned Readmission ◽

Diabetic Patients ◽

Acs Nsqip ◽

Increased Risk

Category: Ankle Introduction/Purpose: Ankle fractures are amongst the most common type of fracture injury in adults with an annual incidence of 187 fractures per 100,000 people in the United States. Previous groups have shown that diabetes mellitus (DM) is associated with a myriad of complications – including infection, malunion, and impaired wound healing – following open reduction internal fixation (ORIF) surgery for ankle fractures. However, to our knowledge there has not been a large-scale nationwide study on the rate of readmission, reoperation, and mortality associated with DM. The purpose of this study was to calculate the increased risk and odds ratios for 30-day postoperative readmission, reoperation, and mortality after ankle fracture ORIF. Methods: Patients who underwent ORIF for ankle fractures from 2006 to 2015 were identified in the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database using Current Procedural Terminology codes. Median values along with 25th to 75th interquartile ranges (IQRs) were used to describe continuous variables and frequency (%) was used to describe categorical variables. Patient demographic factors along with 30-day postoperative outcomes were compared between those who had DM and those who did not have DM using the Mann-Whitney test or?2 test. 30-day postoperative unplanned readmission, unplanned reoperation, and mortality rates were compared in 2,044 patients with DM and 15,420 patients without DM. Crude odds ratios (OR) and adjusted ORs controlling for age differences were calculated for each parameter with a 95% confidence interval (CI). All statistical analyses were performed with a significance level of 0.05. Results: Patient factors and pre-operative laboratory statistics are summarized in Figure 1D, and the distribution of ankle fractures types are shown in Figure1A&B. Comparing patients with DM vs without DM, the rate of readmission was 4.35% vs 1.50%, rate of reoperation was 2.30% vs 0.75%, and rate of mortality was 0.73% vs 0.21%. As shown in Figure 1C, we found that patients with DM had a 2.66 times increased risk of readmission (CI: 1.99-3.52, p = 0.0001), 2.76 increased risk of reoperation (CI: 1.91-3.92, p = 0.0001), and a 2.34 increased risk of mortality (CI: 1.19-4.44, p = 0.0377). Interestingly, we also found a 22.06 increased risk of amputation (CI: 3.29-344.8, p = 0.0063) though the rate of amputation in both groups was very small. Conclusion: In this large-scale retrospective study we showed that the presence of diabetes mellitus significantly increases the risk of unplanned readmission, unplanned reoperation, and mortality within 30 days after ankle fracture ORIF surgery. Thus, patients with diabetes that require ORIF ankle surgery should be informed of their increased risk of complications and extra precautions should be taken to minimize risk. Further research in optimization of perioperative care for diabetic patients is crucial to reducing rates of complication. Large clinical databases such as ACS-NSQIP should endeavor to collect more parameters on diabetic patients to facilitate these studies.

Download Full-text

Risk Factors for Fracture in Diabetes: The Canadian Multicentre Osteoporosis Study

ISRN Epidemiology ◽

10.5402/2013/249874 ◽

2013 ◽

Vol 2013 ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Lisa-Ann Fraser ◽

Alexandra Papaioannou ◽

Jonathan D. Adachi ◽

Jinhui Ma ◽

Lehana Thabane

Keyword(s):

Rheumatoid Arthritis ◽

Risk Factors ◽

Family History ◽

Female Gender ◽

Diabetic Patients ◽

Mineral Density ◽

Cross Sectional ◽

Increased Risk ◽

Traumatic Fracture ◽

History Of

Objective. Individuals with diabetes have been found to be at increased risk of nontraumatic fracture. However, within the diabetic population, how to distinguish who is at the highest risk and warranting therapy has remained elusive. Design. Cross-sectional analysis of a national population-based cohort study. Patients. Men and women over the age of 50 with diabetes from across Canada. Measurements. Logistic regression analysis to identify diabetes specific factors associated with a history of one or more non-traumatic fractures. Results. Six hundred and six individuals with diabetes with a mean age of 69 years were examined. Thirty percent had a history of non-traumatic fracture. Macrovascular diseases in the form of stroke or TIA, as well as hypertension, were found to be independently associated with fragility fracture. Other, more traditional, clinical risk factors were also associated with fracture, including increased age, female gender, rheumatoid arthritis, family history of osteoporosis, and decreased bone mineral density. Conclusions. In this cohort of Canadians with diabetes, those with rheumatoid arthritis, a family history of osteoporosis, female gender, increased age, decreased BMD, cerebrovascular disease, or hypertension were more likely to have had a non-traumatic fracture. These risk factors may be important to clinicians when identifying which of their diabetic patients are at highest risk of fracture and in need of preventative therapies.

Download Full-text

A Different View to Older Diabetics: Management of Treatment According to Cognitive Functions

Romanian Journal of Diabetes Nutrition and Metabolic Diseases ◽

10.2478/rjdnmd-2019-0024 ◽

2019 ◽

Vol 26 (3) ◽

pp. 235-241

Author(s):

Remzi Bahsi ◽

Deniz Mut Sürmeli ◽

Tuğba Turgut ◽

Hande Selvi Oztorun ◽

Volkan Atmıs ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Cognitive Impairment ◽

Correlation Analysis ◽

Cognitive Functions ◽

Insulin Treatment ◽

Systemic Disease ◽

Diabetic Patients ◽

Drug Choice ◽

Increased Risk

Abstract Background and aims. Diabetes Mellitus is a chronic systemic disease which has multiple complications and the presence of these complications affects the management of disease. It is also important to consider cognitive functions when managing the treatment of older diabetics. In this study, we aimed to make proposals for the appropriate drug choice to preserve cognitive functions in elderly diabetics. Matherial and methods. A total of 270 older diabetic patients were reviewed. Possible risk factors of cognitive impairment were investigated. Correlation analysis was performed between MMSE and GDS, age, HbA1c, duration of diabetes. Results. Sulfonylurea (adj. OR: 2.33, %95 CI: 1.11-4.90) and insulin treatment (adj. OR: 3.79, %95 CI: 1.56-9.21) were found associated with increased risk of cognitive impairment. In addition, there was a negative correlation between MMSE and GDS (r: -.129, p<0.05). Conclusion. We suggest that insulin and sulfonylureas should be used with caution in those with cognitive impairment.

Download Full-text

The Effect of Diabetes Mellitus on Surgical Site Infections after Colorectal and Noncolorectal General Surgical Operations

The American Surgeon ◽

10.1177/000313481007600722 ◽

2010 ◽

Vol 76 (7) ◽

pp. 697-702 ◽

Cited By ~ 28

Author(s):

Ashar Ata ◽

Brian T. Valerian ◽

Edward C. Lee ◽

Sharon L. Bestle ◽

Sarah L. Elmendorf ◽

...

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Emergency Surgery ◽

Operation Time ◽

Red Blood Cell Transfusion ◽

Dependent Diabetes Mellitus ◽

Diabetic Patients ◽

Improvement Program ◽

Large Hospital ◽

Increased Risk

Patients undergoing colorectal surgery (CRS) are known to be at increased risk of surgical site infection (SSI). We assessed the effect of diabetes and other risk factors on SSI in patients undergoing CRS and patients undergoing general surgery (GS). American College of Surgeons National Surgical Quality Improvement Program Participant Use Data File from 2005 to 2006 was used. χ2 tests, t tests, and logistic regression were used to assess the risk factors. Of the 129,909 study patients 10.1 per cent were patients undergoing CRS. The incidence of SSI in patients undergoing CRS was 3.8 times higher (95% CI, 3.6–4.1) than in patients undergoing GS. The incidence of SSI was higher in diabetics than nondiabetics in patients undergoing CRS (15.4 vs 11.0%, P < 0.001) and patients undergoing GS (5.3 vs 3.1%, P < 0.001). The significant univariate predictors of SSI for patients undergoing GS and patients undergoing CRS were: males, American Society of Anesthesiologists (ASA) class, diabetes emergency surgery, operation time, and greater than 2 units of intraoperative red blood cell transfusion. For patients undergoing GS, increasing age was also significant. After multivariate adjustment, significant predictors of SSI for patients undergoing GS and patients undergoing CRS were: male gender, diabetes, ASA class, emergency surgery, and operation time. For patients undergoing GS, age also remained significant. Among patients undergoing CRS, insulin-dependent diabetes mellitus (IDDM) and noninsulin-dependent diabetes mellitus (NIDDM) were 1.32 ( P < 0.05) times more likely than nondiabetics to develop SSI. Among patients undergoing GS, only IDDM (OR, 1.39; P < 0.001) were at increased risk. In this large hospital-based study, patients undergoing CRS were three times more likely to get SSI than patients undergoing GS. Diabetic patients with CRS (IDDM and NIDDM) and patients undergoing GS (IDDM) were at increased risk of SSI compared with nondiabetics. More intense glycemic control may reduce SSI in patients undergoing CRS with diabetes.

Download Full-text

Duplex ultrasound: A diagnostic tool for carotid stenosis management in type 2 diabetes mellitus

African Journal of Primary Health Care & Family Medicine ◽

10.4102/phcfm.v5i1.414 ◽

2013 ◽

Vol 5 (1) ◽

Author(s):

Yogan Kisten ◽

Pravesen Govender ◽

Nadraj G. Naidoo ◽

Dhiro Gihwala ◽

Ferial Isaacs

Keyword(s):

Diabetes Mellitus ◽

Risk Factors ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Carotid Stenosis ◽

Diagnostic Tool ◽

Duplex Ultrasound ◽

Diabetic Patients ◽

Increased Risk

Background: Diabetic patients are at increased risk of developing cardiac events and stroke, and prevention of diabetes mellitus is therefore desirable. Marked geographical and ethnic variation in the prevalence of diabetes caused by urbanisation, demographic and epidemiological transitions has rendered this one of the major non-communicable diseases in South Africa. Duplex ultrasound (DUS) plays an important role in primary health care in early detection of carotid atherosclerotic disease and the degree of carotid stenosis present. It is a reliable, cost-effective and non-invasive diagnostic tool. The purpose of this study was to determine the role of ultrasound in carotid stenosis management in type 2 diabetes mellitus (T2DM).Objectives: To determine the prevalence of carotid stenosis in a selected T2DM population using DUS and to correlate these findings with other predisposing atherosclerotic risk factors.Methods: The study setting was at an academic hospital in the Western Cape using carotid DUS reports of 103 diabetic subjects ≥ 35 years old. Predisposing risk factors were correlated with degree of carotid stenosis present. Data were analysed using the Fischer exact test, Chisquare and Student t-test.Results: Carotid DUS reports of 63 out of 103 T2DM patients revealed no evidence of a carotid stenosis, thereby lowering the risk profile. Forty patients were identified as having carotidstenosis; 22 symptomatic patients had a > 70% carotid stenosis which warranted surgicalintervention. A greater prevalence of stenosis in the Caucasian group, in both the male (p =0.0411) and female (p = 0.0458) cohorts, was noted. The overall trend suggested a relationship between T2DM and lifestyle, and a statistically significant relationship (p = 0.0063) between smoking and carotid stenosis was observed.Conclusion: T2DM and predisposing atherosclerotic risk factors significantly increased thepossibility of carotid stenosis development.

Download Full-text

Effect of Diabetes Mellitus and Anti-Diabetic Drugs on Bone Health-A Review

Journal of Bioresource Management ◽

10.35691/jbm.1202.0187 ◽

2021 ◽

Vol 8 (2) ◽

pp. 131-148

Author(s):

Farah Deeba ◽

Sidra Younis ◽

Nida Qureshi ◽

Tahmina Mustafa ◽

Nadia Iqbal ◽

...

Keyword(s):

Diabetes Mellitus ◽

Bone Mass ◽

Bone Fracture ◽

Bone Health ◽

Diabetic Patients ◽

Mineral Density ◽

Type 2 Diabetic Patients ◽

Increased Risk

Osteoporosis and diabetes mellitus (DM) are widespread diseases and have a significant health burden. Type-1 diabetes mellitus (T1DM) and Type-2 diabetes mellitus (T2DM) are associated with an increased bone fracture. In T1DM, the increased risk of bone fracture is associated with low bone mass. In patients with T2DM, the risk of fracture of the bone is increased due to low quality of bone, despite increased bone mineral density (BMD). In type 2 diabetic patients, bone fragility depends on the quality of bone instead of a reduction in bone mass. Thiazolidinediones (TZD) cause differentiation of adipocytes and inhibit differentiation of osteoblast and bone marrow stromal stem cells (BMSC). In this review, we have described the effect of anti-diabetic drugs and diabetes mellitus on bone health and our finding shows that sulfonylureas and metformin have no negative effect on bone health and protect bones against fractures.

Download Full-text

Update on the impact of type 2 diabetes mellitus on bone metabolism and material properties

Endocrine Connections ◽

10.1530/ec-18-0456 ◽

2019 ◽

Vol 8 (3) ◽

pp. R55-R70 ◽

Cited By ~ 10

Author(s):

Ann-Kristin Picke ◽

Graeme Campbell ◽

Nicola Napoli ◽

Lorenz C Hofbauer ◽

Martina Rauner

Keyword(s):

Diabetes Mellitus ◽

Type 2 Diabetes ◽

Type 2 Diabetes Mellitus ◽

Material Properties ◽

Bone Fragility ◽

Diabetic Patients ◽

Mineral Density ◽

Increased Risk ◽

The Impact

The prevalence of type 2 diabetes mellitus (T2DM) is increasing worldwide, especially as a result of our aging society, high caloric intake and sedentary lifestyle. Besides the well-known complications of T2DM on the cardiovascular system, the eyes, kidneys and nerves, bone strength is also impaired in diabetic patients. Patients with T2DM have a 40–70% increased risk for fractures, despite having a normal to increased bone mineral density, suggesting that other factors besides bone quantity must account for increased bone fragility. This review summarizes the current knowledge on the complex effects of T2DM on bone including effects on bone cells, bone material properties and other endocrine systems that subsequently affect bone, discusses the effects of T2DM medications on bone and concludes with a model identifying factors that may contribute to poor bone quality and increased bone fragility in T2DM.

Download Full-text

Expert consensus on relevant risk predictors for the occurrence of osteoporotic fractures in specific clinical subgroups – Delphi survey

BMC Rheumatology ◽

10.1186/s41927-019-0099-y ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Nicolas S. Bodmer ◽

Hans Jörg Häuselmann ◽

Diana Frey ◽

Daniel Aeberli ◽

Lucas M. Bachmann

Keyword(s):

Risk Factors ◽

Assessment Tool ◽

Osteoporotic Fractures ◽

Delphi Survey ◽

Expert Consensus ◽

Secondary Osteoporosis ◽

Mineral Density ◽

Predictive Parameters ◽

Fracture Risk Assessment Tool ◽

Risk Of Falls

Abstract Background There is an ongoing discussion about incorporating additional risk factors to established WHO fracture risk assessment tool (FRAX) to improve the prediction accuracy in clinical subgroups. We aimed to reach an expert consensus on possible additional predictive parameters for specific clinical subgroups. Methods Two-round modified Delphi survey: We generated a shortlist of experts from the authors’ lists of the pertinent literature and complemented the list with experts known to the authors. Participants were asked to name possible relevant risk factors besides the FRAX-parameters for the occurrence of osteoporotic fractures. Experts specified these possible predictors for specific subgroups of patients. In the second round the expert panel was asked to weight each parameter of every subgroup assigning a number between one (not important) to ten (very important). We defined the threshold for an expert consensus if the interquartile range (IQR) of a predictor was ≤2. The cut-off value of the median attributed weights for a relevant predictor was set at ≥7. Results Eleven experts of seven countries completed both rounds of the Delphi. The participants agreed on nine additional parameters for seven categories. For the category “secondary osteoporosis”, “older adults” and “nursing home patients”, there was a consensus that history of previous falls was relevant, while for men and postmenopausal women, there was a consensus that the spine fracture status was important. For the group “primary and secondary osteoporosis” the experts agreed on the parameters “high risk of falls”, “lumbar spine bone mineral density (BMD)” and “sarcopenia”. Conclusion This Delphi survey reached a consensus on various parameters that could be used to refine the currently existing FRAX for specific clinical situations or patient groups. The results may be useful for studies aiming at improving the predictive properties of instruments for fracture prediction.

Download Full-text