4.7.0.0 Frac­tures

Age-‍specific hip frac­ture risk is significant­ly in­creased in peo­ple with both type 1 (rel­a­tive risk 6.3) and type 2 (rel­a­tive risk 1.7) di­a­betes in both sexes (62). Type 1 di­a­betes is as­so­ci­at­ed with os­teo­poro­sis, but in type 2 di­a­betes, an in­creased risk of hip frac­ture is seen de­spite high­er bone min­er­al den­si­ty (BMD) (63). In three large ob­ser­va­tion­al stud­ies of older adults, femoral neck BMD T score and the World Health Or­ga­ni­za­tion Frac­ture Risk As­sess­ment Tool (FRAX) score were as­so­ci­at­ed with hip and non­spine frac­tures. Frac­ture risk was high­er in par­tic­i­pants with di­a­betes com­pared with those with­out di­a­betes for a given T score and age or for a given FRAX score (64). Pro­viders should as­sess frac­ture his­to­ry and risk fac­tors in older pa­tients with di­a­betes and rec­om­mend mea­sure­ment of BMD if ap­pro­pri­ate for the pa­tient’s age and sex. Frac­ture pre­vention strate­gies for peo­ple with di­a­betes are the same as for the gen­er­al pop­u­la­tion and in­clude vi­ta­min D sup­ple­men­ta­tion. For pa­tients with type 2 di­a­betes with frac­ture risk fac­tors, thi­a­zo­lidine­diones (65) and sodi­um–glu­cose co­trans­porter 2 in­hibitors (66) should be used with cau­tion.