Diabetes and Hip Fractures: an Important Underrepresented Topic in the Related Literature

Review Article

Austin J Endocrinol Diabetes. 2015;2(1): 1033.

Diabetes and Hip Fractures: an Important Underrepresented Topic in the Related Literature

Marks R*

Department of Health and Behavior Studies, Teachers College, Columbia University, USA

*Corresponding author: Marks R, Department of Health and Behavior Studies, Teachers College, Columbia University Box 114, 525W 120th Street, New York,

Received: February 13, 2015; Accepted: April 26, 2015; Published: May 06, 2015


Diabetes prevalence is increasing rapidly among older populations, who are also at high risk for hip fractures. This article examines whether hip fracture risk is increased in the presence of a diabetes diagnosis, and if so what are the ramifications of this association. It also examines the risk factors for incurring a hip fracture in the presence of diabetes, and the increased risk of adverse outcomes experienced by hip fracture patients with diabetes. Possible implications of this body of literature include efforts to reduce the risk and burden of hip fractures among the elderly as well as the severity of diabetes, in general. This article which provides a synthesis of this topic may hence be of value to clinicians interested in preventing adverse diabetes outcomes, as well as those who strive to promote healthy aging and positive life quality among the elderly with either type 1 or type 2 diabetes.

Keywords: Bone diabetes; Falls; Fracture; Hip fracture; Type 1 and Type 2 diabetes


Hip fractures are a well-established prominent cause of premature and excessive morbidity, as well as mortality among aging adults [1]. As well, type 2 diabetes, is an increasingly prevalent health problem among the older population, along with type 1 diabetes, and both forms affect multiple organs and body systems. This brief examines the role of diabetes in general, in increasing the risk of sustaining a hip fracture among the elderly. It also examines evidence for poor post surgical outcomes after hip fracture. As well, it examines what can be done to minimize this risk, given the finding diabetes clearly increases the risk for hip fractures [2], as well as the outcomes of hip fractures among the elderly quite negatively [3-6]. Based on the most recent data in the literature, the topics discussed in this review are hip fractures and their relationship to diabetes, diabetes and bone health, diabetes and falls injuries, and potential prevention strategies to offset hip fracture prevalence and severity among older adults. This effort was undertaken given the apparent lack of attention to the impact of diabetes on musculoskeletal health status, when compared to physical status and glycemic control issues alone. It was hypothesized that adults with both type 1 and type 2 diabetes are at higher risk for falls that lead to hip fractures, as well as poorer health outcomes. It was also believed there would be few publications drawing attention to the need for vigilance against this debilitating health condition in the current literature compared to the number of nutrition and physical activity related recommendations even though this information is quite compelling. Limited post hip fracture rehabilitation strategies that are modified in light of the impact of diabetes on this process were expected even though reasons for the increased hip fracture risk and poor outcomes in this group are largely modifiable factors.

The specific questions were:


Data sources sought were those that might provide topical information and interrelated data on diabetes and hip fractures, the possible causes of hip fractures among diabetics, and the implications of diabetes for preventing hip fractures in the peer reviewed literature. Data sources used were those published in the English language and covering the years 1993-2014, located in Academic Search Complete, which yielded 237 articles, many of which were housed in Pubmed or Cihahl or both using the key works Diabetes and Hip fracture; Diabetes and Falls; Diabetes and Balance; Hip Fracture Epidemiology; Hip Fracture Outcomes. Due to the diversity of the literature a metaanalysis was not conducted, rather a narrative synthesis of the data from clinical studies, and systematic reviews was conducted.


Diabetes and hip fracture risk: The examination of whether diabetes type 1 or 2 or both increases the risk for hip fractures has proceeded for more than 15 years. As outlined in (Table 1), many of these studies have been prospective in nature with large samples and have tended to conclude people with diabetes are more likely to be at increased risk for hip fracture than not. Although these studies reported in (Table 1) do not clearly differentiate type 1 from type 2 diabetes in all cases, according to Hothersall et al. [7]. who recently examined the risk of incurring a hip fracture among patients ages 20- 84 years with either type I or type 2 diabetes in a national sample from Scotland, a substantial increase of risk of hip fracture is present among patients with type 1 diabetes, especially at higher ages, but not among patients with type 2 diabetes, except for a small risk among women. However, these data were extracted from a pre-collected data base and may not have exemplified confounding factors or how type 2 diabetes affects hip fractures, as this is often undetected, even if present. The results presented by Hothersall et al. [7]. were also inconsistent with those of Lipscombe et al. [8]. who showed older individuals with diabetes are at increased risk for hip fractures. Janhorbani et al. [2], similarly found type 1 as well as type 2 diabetes are associated with an increased risk of hip fracture among women, when comparing rates to women without diabetes.