CMAJ • November 20, 2007; 177 (11). doi:10.1503/cmaj.1070141.
© 2007 Canadian Medical Association or its licensors
All editorial matter in CMAJ represents the opinions of the authors and not necessarily those of the Canadian Medical Association.
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Letters

Diabetes and osteoporotic fractures

Luca Mascitelli, MD* and Francesca Pezzetta, MD{dagger}

*Cardiologist and Sports Medicine Physician, Comando Brigata Alpina "Julia", Udine, Italy; {dagger}Cardiologist, Ospedale di San Vito al Tagliamento, San Vito al Tagliamento, Italy

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.

Footnotes

Competing interests: None declared.


REFERENCES

  1. Cranney A, Jamal SA, Tsang JF, et al. Low bone mineral density and fracture burden in postmenopausal women. CMAJ 2007;177:575-80.[Abstract/Free Full Text]
  2. Schwartz AV, Sellmeyer DE, Ensrud KE, et al. Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 2001;86:32-8.[Abstract/Free Full Text]
  3. Strotmeyer ES, Cauley JA, Schwartz AV, et al. Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults. Arch Intern Med 2005;165:1612-7.[Abstract/Free Full Text]
  4. Meyer HE, Tverdal A, Falch JA, et al. Factors associated with mortality after hip fracture. Osteoporos Int 2000;11:228-32.[CrossRef][Medline]
  5. Mascitelli L, Pezzetta F, Songini M. Detrimental action of thiazolidinediones on bone. Eur J Intern Med 2007;18:447.[Medline]




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