Epidemiology of Fractures in Diabetes

Diabetes mellitus is associated with an increased risk of fracture. The risk of a hip fracture is up to sevenfold increased in patients with type 1 diabetes and about 1.3-fold increased in patients with type 2 diabetes. However, these relative risk estimates may depend on the age and gender distribution of the population in question. Bone mineral density and the fracture risk assessment tool do not explain the increased fracture risk in patients with diabetes. Shared risk factors as pancreatitis, alcohol use, smoking and oral glucocorticoids may influence the observed fracture risk in patients with diabetes. This review examines the association between diabetes and fracture and attempts to disentangle the tight connection between diabetes per se, diabetes-related complications, comorbidities and shared risk factors. This is of great importance as the number of diabetes patients' increases with growing and aging populations and putting even more at risk of fracture.