Hip fractures in particular are now recognized not only as a major cause of morbidity and mortality, but also for their significant economic and social impact.Hip fractures are increased in patients with diabetes. Case-control studies of patients with hip fractures have found an excess of patients with diabetes, suggesting at least a twofold relative risk in all patients with diabetes.
IGF-1 is a growth factor that's "built" a lot like insulin (hence the name insulin-like growth factor). Growth factors stimulate cells to grow and divide, and different growth factors affect different kinds of cells throughout the body. IGF-1 interacts with most cells in the body, but it affects cells in the organs, nerves, skin, cartilage, and bone in particular.
The more IGF-1 someone has, the higher their bone mineral density. People with diabetes have low levels of IGF-1, and they often have low bone density." Therefore, low IGF-1 levels related to diabetes may also contribute to low bone density.
Women with type 1 diabetes had a 6.9- to 12-fold relative risk of hip fractures compared to women without diabetes.The one site with an undisputed increased fracture risk is the foot, which may be related in part to obesity or neuropathy. Focal osteopenia and fractures associated with severe peripheral neuropathy (Charcot foot) are long recognized as a complication of any type of diabetes.
The lifetime risk of fracture in women in developed countries may be as high as 40% which includes mostly low trauma fractures sustained by the elderly due to underlying osteoporosis.The targeting of risk factors for osteoporosis and fracture requires knowledge of the risk factors in different societies. For example, as mentioned by Nakamura and Fujiwara, the risk of hip fracture in Japan is increased with coffee drinking and sleeping in a bed rather than on a mat.
Another case study suggested that the association between type of diabetes and hip fracture incidence was stronger for type 1 diabetes than for type 2 diabetes .Type 2 diabetes was weakly associated with fractures at other sites, and most effect estimates were not statistically significant. These findings strongly support an association between both type 1 and type 2 diabetes and increased risk of hip fracture in men and women.
Amitriptyline as the tricyclic drug of choice for the treatment of symptomatic peripheral diabetic neuropathy; have adverse effects in older patients. Older diabetic patients frequently have coexisting conditions, such as orthostatic hypotension, urinary retention, constipation, cognitive impairment, or a history of falls.The researchers found that hip bone density decreased significantly more in women who took rosiglitazone than in those who took a placebo.
Study found that as many as one in fifteen type 1 diabetic patients could break their hip before the age of 65. For this reason, the researchers think it is important to develop methods for controlling diabetes and protecting against broken bones.Presence of diabetic retinopathy, advanced cortical cataract, diabetes duration, and treatment with insulin were significantly associated with increased risk of fractures.
Obesity is associated with type 2 diabetes and with increased levels of estrogen, which may decrease hip fracture risk among obese women. In addition, obesity provides cushioning for the hip in the event of a fall. Case control study indicates that women with type 1 or type 2 diabetes are at increased risk for hip fracture. These findings highlight the need for fracture prevention efforts in individuals with diabetes.The association between type 2 diabetes and hip fracture was similar among obese and nonobese women . Also, in both obese and nonobese women with type 2 diabetes, the risk of fracture increased with increasing duration of diabetes.
A study resulted that older white and black adults with DM are at higher fracture risk compared with nondiabetic adults with a similar bone mineral density (BMD) since a higher risk of nontraumatic fractures was found after adjustment for hip BMD . Fracture prevention needs to target specific risk factors found in older adults with diabetes mellitus (DM) .
Men and women with diabetes, either type 1 or type 2, are more likely than the general population to fracture a hip, according to a review of studies reported in the American Journal of Epidemiology.
Numerous studies have been published since the early 1980s analyzing the relationship between diabetes and fractures, but study findings were inconsistent.
Clinical trials with insufficient statistical power may have contributed to the contradictory results, lead author Dr. Mohsen Janghorbani, currently based at Isfahan University of Medical Sciences in Iran, and associates suggest. They therefore conducted an analysis of published trial results regarding diabetes and low-trauma hip fractures.
They reviewed a total of 16 studies that included 836,941 adult subjects and 139,531 fractures.
Twelve studies that examined the link between type 2 diabetes and hip fracture found that diabetics were 70 percent more likely to fracture a hip, a statistically significant difference.
Six studies found a statistically significant increased risk in hip fracture for type 1 diabetes patients, who were more than 6-times more likely to break a hip.
"Results were consistent between studies of men and women and between studies conducted in the United States and Europe," Janghorbani and associates report.
They surmise that impaired bone quality may be one culprit responsible for the increased risk of hip fractures among diabetics.
Another possibility, the investigators add, may be diabetes-related complications, such as diabetic retinopathy, which cause loss of vision; peripheral neuropathy, a nerve disorder that may impair the ability to walk or balance; low blood sugar, which can cause patients with be dizzy or to faint; and stroke - all of which may increase the risk of falls.
To protect yourself against these fractures, the association suggests:
* Getting recommended daily amounts of calcium (1,000-1,500 milligrams/day) and vitamin D (400-800 international units). The vitamin D is particularly warranted for those with little sun exposure.
* Research indicates that women taking estrogen, calcium or calcitonin had a significantly lower risk of a hip fracture than those who were not. Women who had been treated longest had the lowest risk.
* Getting regular exercise to help keep bones strong. Exercise that involves standing upright, such as walking, is best for the hips and spine. It also helps maintain muscle coordination and balance, which decreases the risk of falls.
* Asking your doctor whether a walker would help you, especially if you have neuropathy or poor balance.
* Using nightlights in your bathroom and in the hallway leading to the bathroom.
* Other medical conditions also may lead to bone fragility either by slowing bone formation or by speeding up bone loss. These include endocrine disorders, such as hypogonadism or type 1 diabetes; gastrointestinal disorders, which may interfere with calcium and vitamin D absorption; and rheumatoid disorders, which often lead to inactivity and loss of bone mass. Prolonged bed rest or immobility also can lead to bone loss.
* Eliminating throw rugs that might slip.
* Arthroscopic release of the diabetic persistent frozen shoulder to be an effective method of treatment
* Home care programs for the elderly are becoming increasingly popular. Recovery Most elderly patients who fracture a hip continue to decline in health one year after discharge from hospital.
These steps can help you guard against hip fracture by reducing your risk of falls:
* Fall-proof your home. Keep your home well lit and free of hazards that might cause you to trip and fall. Avoid area rugs and exposed electrical cords. Place furniture where you're unlikely to bump into it. Consider installing grab bars in your bathroom, stair treads on steps and handrails along stairways. Use nonslip mats on the bathtub and on shower floors.
* Wear sensible shoes. If you're older, wear thinner, hard-soled, flat shoes. Resilient-soled athletic shoes may impair your balance and contribute to falls. Avoid wearing high heels or sandals with light straps. Avoid wearing shoes that are either too slippery or too sticky.
* Avoid strenuous and dangerous activities. Don't stretch to reach high places. Use a stepladder or ask for help. Avoid lifting heavy objects, climbing and engaging in unusually vigorous activities.
* See your eye doctor. Poor eyesight is a possible cause of falls. If you're having trouble seeing, have your eyes checked. Wearing proper glasses and being able to see well around your home makes it more likely that you'll see objects that you might trip over.
* Be mindful of side effects of medications. Feeling weak or dizzy, which are possible side effects of many medications, can increase your risk of falling. Talk to your doctor about side effects caused by your medications.
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