Diabetes and osteoporotic fractures

In a recent study of bone mineral density and fracture burden in postmenopausal women, Ann Cranney and colleagues reported that most of the fractures in their study population occurred in women with normal or osteopenic bone mineral density.1 The authors suggested that factors other than bone mineral density may influence bone strength or the risk of falls and thereby contribute to fracture risk. However, they did not mention type 2 diabetes mellitus as a potential factor contributing to fracture risk.

Mounting evidence suggests that patients with type 2 diabetes may be at increased risk of having certain types of osteoporotic fractures even if their bone mineral density is high.2^,3 Of note, diabetes has been shown to be a risk factor for increased mortality in patients with a hip fracture.4 The fact that the number of patients with diabetes who are being treated with thiazolidinediones is increasing might help to explain the higher fracture risk.5 Thus, type 2 diabetes should be considered as an important clinical risk factor in the calculation of future fracture risk.