Why Do Falls and Lower Limb Fractures Occur More Frequently in the Diabetic Patient and How Can They Be Prevented?

Abstract

Due to primarily sarcopenia and hypoglycemia but also neuropathy, hypotension, analgesics and polypharmacy, there is an increased incidence of falls and hip fractures in both the type 1 and type 2 diabetic patient. Utilization of insulin, hypotensive drugs, analgesics and perhaps canagliflozin further increases the risk. Thiazolidinedione use may increase the risk of osteoporosis and fracture. Prolonged hyperglycemia resulting in cross-linking of collagen and advanced glycosylation end products alter the microarchitecture and increase bone fragility. Higher serum vitamin D levels seem to decrease the incidence of both falls and fractures. Following a hip fracture, mortality in the diabetic patient is increased largely because of cardiovascular events and pneumonia. Prevention of sarcopenia includes dietary therapy, vitamin D and testosterone replacement when appropriate.

Evaluation of Bone Mineral Density, Serum Osteocalcin, and Osteopontin Levels in Postmenopausal Women with Type 2 Diabetes Mellitus, with/without Osteoporosis

“…Patients with type 1 DM have a lower BMD whereas those with T2DM are at a higher risk of experiencing a bone fracture, given their high or average BMD as measured by dual-energy X-ray absorptiometry (DXA) [ 4 , 5 ]. Other causes that contribute to the development of fractures in patients with T2DM include sarcopenia, impaired balance due to peripheral neuropathy, diabetic retinopathy, and medications used in diabetes [ 6 , 7 ].…”

Risk factors for falls in older adults with diabetes mellitus: systematic review and meta-analysis

“…The falls occurred in the hospital setting in only two studies [ 28 , 34 ]. Hospital falls are a frequent and worrisome problem in the world and prevention strategies that should be more widely implemented are the education of physicians, modification of the environment, assistive devices, hospital systems, and medication reviews [ 54 ]. As we have noted, in both hospital and community settings, intrinsic and extrinsic factors may contribute to an increased risk of falls in the population of older adults with T2DM.…”

“…This reinforces the importance of education in the rational use of medications and insulin, together with nutritional support and physical activities that may contribute to a decrease in the risk of falls in older adults with T2DM. Another result of these preventive measures would be a reduction in healthcare costs, considering the high level of care required and the increased length of hospital stays associated with falls in this population [ 54 , 59 ].…”