MedWire News: Women with diabetes have decreased femoral neck strength, despite having higher bone mineral density (BMD) than women without diabetes, research shows.
The findings support earlier studies showing that women with diabetes have a two-fold greater risk for fracture compared with women without diabetes.
"The impact of hip fracture is even greater in diabetic patients because of delayed healing and increased risk of complications," report Shinya Ishii (University of Tokyo, Japan) and colleagues in the Journal of Clinical Endocrinology and Metabolism.
Although studies have shown these diabetes patients are at an increased risk for hip and osteoporotic fractures, several longitudinal studies have reported higher BMD in women with diabetes.
In the present analysis, the researchers measured three composite indices of bone strength in 1887 women just prior to or in early menopausal transition, including femoral neck strength integrates for compression, bending, and impact, femoral neck size, and femoral neck areal (a)BMD.
Of those studied, 81 women had diabetes and 291 women were prediabetic, defined as a fasting glucose level of 100 mg/dL or above.
The crude mean femoral neck aBMD was significantly higher in patients with prediabetes and diabetes than those without diabetes. The women with diabetes also had higher crude mean femoral neck aBMD than women with prediabetes.
By contrast, the unadjusted mean of the three composite strength indices were significantly lower in the diabetes and prediabetes women compared with women without diabetes.
The differences in the strength indices were 7% between the patients with prediabetes and diabetes, and 16% between the women with and without diabetes.
After adjusting for age, race/ethnicity, menopausal stage, body mass index, smoking, physical activity, and calcium and vitamin D supplementation, the women with diabetes had higher femoral neck aBMD, but significantly lower composite strength indices than women without diabetes.
The researchers also observed an inverse association between femoral neck composite strength indices and insulin resistance, "suggesting that insulin resistance may be a cardinal pathway to lower bone strength and increased fracture risk in Type 2 diabetes."
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