Type 2 diabetes is a chronic condition that affects millions of people worldwide, with a significant impact on overall health. Among older women, this condition not only poses the usual health risks associated with diabetes but also increases the risk of fractures. While this increased risk is partly due to changes in bone health, the primary reason is often linked to poorer physical function, which makes these women more susceptible to falls. Here we will explore why older women with type 2 diabetes are more prone to fractures and how this relates to both bone health and physical performance.

Link Between Type 2 Diabetes and Fractures

Older women with type 2 diabetes face a higher risk of fractures compared to those without the condition. This elevated risk is primarily attributed to poorer physical health, which leads to an increased likelihood of falls rather than directly weaker bones. Previous research on the bone structure of people with type 2 diabetes has shown mixed results, with some studies suggesting that while bone density may be higher, the overall structure of the bone is often weaker (1).

Physical Performance and Fracture Risk in Older Women with Type 2 Diabetes

A recent Swedish study provides valuable insights into why women aged 75-80 with type 2 diabetes are more prone to fractures (2). The study, led by Dr. Mattias Lorentzon, a professor in geriatric medicine at Gothenburg University, examined the physical performance and bone health of older women with type 2 diabetes. The results were striking- women with diabetes had significantly worse physical performance, including slower movement and lower strength, compared to women without the condition.
This poorer physical function is a crucial factor in the increased fracture risk. When physical performance is impaired, the likelihood of falling increases, which in turn raises the risk of fractures. Dr. Lorentzon’s study highlights that the increased fracture risk in older women with type 2 diabetes is due to falls resulting from reduced physical function, rather than differences in bone density.

Bone Density in Type 2 Diabetes

Bone density has long been considered an important factor in assessing fracture risk. However, the relationship between bone density and fractures in people with type 2 diabetes is complex. The Swedish study found that women with type 2 diabetes had a 4.4% higher bone density in the hip compared to women without diabetes. Similar increases were observed in the femoral neck and lumbar spine. Despite this higher bone density, the study participants with diabetes still faced a higher risk of fractures.

This finding suggests that while bone density might be higher in older women with type 2 diabetes, the quality of the bone may not be as strong. The bones may be denser, but they could also be more brittle and prone to breaking. This paradoxical situation, where higher bone density does not equate to stronger bones, can be partly explained by the impact of high blood sugar levels and inflammation associated with diabetes, which can weaken bone quality.

Role of Physical Function in Fracture Risk

One of the most significant findings of the Swedish study was the impact of physical function on fracture risk. The study participants with type 2 diabetes scored 19.2% lower on the Physical Activity Scale for the Elderly compared to those without diabetes. This lower score reflects a reduced ability to perform everyday physical tasks, which can increase the risk of falls and fractures.

For example, in a balance test where participants were asked to stand on one leg, women with type 2 diabetes could stand for 27.2% less time than those without diabetes. In a separate test measuring lower-body function, these women took 13.9% longer to complete a simple task of rising from a chair, walking a short distance, and returning to the chair. Such impairments in physical function are critical in understanding why older women with diabetes are more likely to experience fractures.

Impact of Diabetes Medication on Bone Health

Another factor contributing to the increased fracture risk in older women with type 2 diabetes is the effect of diabetes medication on bone health. While some medications, such as insulin, are essential for managing blood sugar levels, they may also influence bone health. The Swedish study found that women treated with insulin had a 71% higher risk of fractures compared to controls, while those on oral diabetes medications had a 27% higher risk.

This increased risk may be due to several factors, including the impact of medications on bone density and physical function. For example, while some diabetes medications can help maintain bone density, they may not improve bone quality or physical performance, leading to a higher likelihood of falls and fractures.

Addressing the Risk of Fractures in Older Women with Type 2 Diabetes

Given the increased risk of fractures in older women with type 2 diabetes, it is essential to take steps to address this issue. One potential strategy is to focus on improving physical function, which could help reduce the risk of falls and fractures. Physical therapy, exercise programs, and lifestyle changes aimed at enhancing strength, balance, and mobility could be beneficial for older women with diabetes.

Additionally, managing blood sugar levels and inflammation is crucial for maintaining bone health. Regular monitoring of bone density, combined with a comprehensive approach to diabetes management, can help reduce the risk of fractures in this population.

In conclusion, older women with type 2 diabetes are at an increased risk of fractures, primarily due to poorer physical function rather than reduced bone density. While these women may have higher bone density, their bones may be weaker, and their physical performance is often impaired, leading to a higher likelihood of falls. Addressing this issue requires a multifaceted approach that includes improving physical function, managing blood sugar levels, and taking steps to maintain bone health. By doing so, it is possible to reduce the risk of fractures and improve the overall quality of life for older women with type 2 diabetes.

References:

1. Association between bone mineral density and type 2 diabetes mellitus: a meta-analysis of observational studies
   (Ma L, Oei L, Jiang L, et al. Association between bone mineral density and type 2 diabetes mellitus: a meta-analysis of observational studies. Eur J Epidemiol. 2012;27(5):319-332. doi:10.1007/s10654-012-9674-x)




2. Type 2 Diabetes and Fracture Risk in Older Women
   (Zoulakis M, Johansson L, Litsne H, Axelsson K, Lorentzon M. Type 2 Diabetes and Fracture Risk in Older Women. JAMA Netw Open. 2024;7(8):e2425106. doi:10.1001/jamanetworkopen.2024.25106)

Source-Medindia