Systematic Review: Are the Elderly With Diabetes Mellitus Type 2 Prone to Fragility Fractures?

Abstract

Diabetes mellitus type 2 (T2DM) is an emerging public health issue with high prevalence rates among older adults while fragility fractures constitute a significant public health burden with a great impact. Osteoporosis is the most important metabolic bone disease in patients with diabetes mellitus. Based on current evidence, individuals with T2DM are more vulnerable to fragility fractures than their non-diabetic counterparts, although until now, there aren't any systematic reviews or meta-analyses concerning the impact of T2DM on the risk of fragility fractures in elderly patients. The aim of this study is to fill this gap in the current literature concerning this specific patient group.Literature in PubMed and Google Scholar was searched for relevant articles published up to January 2021. The keywords used were: elderly, diabetes mellitus type 2, and fragility fractures. Among the 180 articles retrieved, only four full-text articles were eligible and, finally, two studies (one population-based cohort study and one cross-sectional study) met the inclusion criteria for the review. Although we identified 15 records through the manual research, finally 17 records were included in the current review. The records retrieved from the manual research were 11 prospective cohort studies, two population-based studies, one prospective observational study, and one retrospective cohort study. The author's name, year of publication, country, type of study, and number of patients were reported.According to this systematic review, there is almost consensus about the increased prevalence of all kinds of fragility fractures and especially low-energy hip fractures among elderly patients with T2DM compared with their counterparts without T2DM while there is relative controversy concerning non-vertebral fractures. Vertebral fractures in the elderly with T2DM require further evaluation because the results from cohort studies are more conflicting. Finally, insulin usage can increase the possibility of fragility fractures and can even double this risk. Bone fragility should be recognized as a new complication of T2DM, especially in elderly patients, due to several additional aggravating factors such as senile osteoporosis, severe vitamin D deficiency, presence of many comorbidities, increased possibility of insulin usage, and the presence of diabetes-related complications (mainly neuropathy and retinopathy). Clinicians who treat these patients should be aware of the special diagnostic and therapeutic approaches concerning these patients.

Network Pharmacology and Molecular Modeling Techniques in Unraveling the Underlying Mechanism of Citri Reticulatae Pericarpium aganist Type 2 Diabetic Osteoporosis

“…Studies have indicated that individuals diagnosed with type 2 diabetes are at an increased risk of developing osteoporosis. At the same time, compared with general age-related osteoporosis, patients with type 2 diabetes osteoporosis tend to be more susceptible to bone fragility due to prolonged exposure to a high-glucose environment [ 3 ]. Hence, as the global population ages, the severity of the situations regarding type 2 diabetic osteoporosis will also increase [ 4 ].…”

Effect of calcium plus Vitamin-D combined with calcitriol in the treatment of patients with Type-2 diabetes and osteoporosis: A retrospective observational analysis

“… 4 , 5 T2DM combined with osteoporosis can increase the complexity and severity of the patient’s condition, affect health, and reduce quality of life. 5 , 6 …”

“…The current treatment methods for T2DM combined with osteoporosis mainly include blood glucose control, calcium and Vitamin-D supplementation, and exercise therapy. 5 - 7 For severe osteoporosis, medication such as bisphosphate can be considered. 7 , 8 Calcium plus Vitamin-D supplements increase calcium and Vitamin-D3 levels, thus promoting bone formation and increasing bone density.…”

Trajectories of social support are associated with health outcomes and depressive symptoms among older Taiwanese adults with diabetes following hip‐fracture surgery

“…10 A systematic review of 17 studies demonstrated an increase in the prevalence of low-energy hip fractures for older adults with DM compared with those without DM. 11 A cohort study of older adults in Taiwan revealed that the risk of hip fracture was greater for patients with DM compared with those without, regardless of a patient's body mass index. 12 Hip fractured patients with DM needed longer rehabilitation following surgery and had lower functional outcomes after rehabilitation as compared with non-diabetic patients.…”

“…Age is a risk factor for hip fracture and diabetes mellitus (DM) can also increase hip fracture risk and complications due to abnormal bone metabolism 10 . A systematic review of 17 studies demonstrated an increase in the prevalence of low‐energy hip fractures for older adults with DM compared with those without DM 11 . A cohort study of older adults in Taiwan revealed that the risk of hip fracture was greater for patients with DM compared with those without, regardless of a patient's body mass index 12 .…”