Diabetes and fractures: an overshadowed association

Purpose of review To review recent literature on fracture risk in patients with type 1 and type 2 diabetes. Recent findings Observational and population studies have reported a higher risk of fractures in patients with type 1 and type 2 diabetes, especially at the hip. Type 2 diabetic patients have a higher bone mineral density compared with the general population, and yet, remain unprotected from fractures. Type 1 diabetic patients have a greater risk of fractures and a lower bone mineral density compared with the general population. Their lower bone mineral density, however, does not fully account for the raised fracture risk. Therefore, impaired bone quality rather than lower bone density appears to mediate the increased fracture risk in patients with type 1 and 2 diabetes. Recently, studies have shown an association between advanced glycation end products with increased fracture risk in diabetic patients. These studies support the hypothesis of poor glycemic control and chronic hyperglycemia having a direct detrimental effect on bone quality. In addition, increased fracture risk has been reported in patients with peripheral and autonomic neuropathy, recurrent hypoglycemic events, vitamin D deficiency, and those receiving thiazolidinedione therapy. Summary Diabetes is associated with an increased risk of fractures in patients with type 1 and type 2 diabetes. Appropriate measures aimed at fracture prevention should be considered in the complex care of the diabetic patient.