Diabetes tied to increased fall, fracture risk

The risk of falls and subsequent injuries (eg, fractures) may be elevated in individuals with diabetes compared with the general population, according to a nationwide cohort study from Denmark.

The researchers of this study used the Danish National Patient Register to identify 12,896 adults (aged >20 years) with type 1 diabetes (T1D) and 407,009 individuals with type 2 diabetes (T2D) and age- and sex-matched them 1:1 to the general population.

All episodes of a first fall leading to hospitalization between 1996 and 2017 were documented. There were 1,726 falls and 695 fall-related injuries (fractures or lesions) among patients with T1D and 48,553 falls and 13,236 fall-related injuries among patients with T2D. In the non-T1D control group, there were 1,687 falls and 620 fall-related injuries, while in the non-T2D control group, there were 46,497 falls and 12,197 fall-related injuries.

After adjusting for multiple risk factors*, the risk of a first fall was increased in patients with T1D (hazard ratio [HR], 1.33, 95 percent confidence interval [CI], 1.25–1.43) and T2D (HR, 1.19, 95 percent CI, 1.16–1.22; p<0.001 for both). [EASD 2020, abstract 279]

The cumulative incidence of falls leading to hospitalization was 13.3 and 11.9 percent of patients with T1D and T2D, respectively.

Factors tied to an increased risk of falls were female sex (HR, 1.21 [T1D] and HR, 1.61 [T2D]), age >65 years (HR, 1.52 and HR, 1.32), use of selective serotonin receptor inhibitors (SSRIs; HR, 1.35 and HR, 1.32), opioid use ( HR, 1.15 and HR, 1.09; p<0.001 for all vs respective controls), and a history of alcohol abuse (HR, 1.77; p=0.006 and HR, 1.88; p<0.001).

Patients with diabetes also had a higher incidence of fractures at certain anatomical sites than the general population.

Patients with T1D had an elevated incidence of hip and femoral fractures compared with the control population (incidence rate ratio [IRR], 1.11, 95 percent CI, 1.02–1.23). Patients with T2D had an increased incidence of fractures of the hip and femur (IRR, 1.02, 95 percent CI, 1.01–1.04), radius (IRR, 1.39, 95 percent CI, 1.18–1.61), humerus (IRR, 1.24, 95 percent CI, 1.12–1.37), and skull/face (IRR, 1.15, 95 percent CI, 1.07–1.24) compared with controls.

“Falls and fall-related injuries are associated with an increased risk of morbidity and mortality,” said study author Dr Nicklas Rasmussen from the Steno Diabetes Center North Jutland, Aalborg University Hospital, Aalborg, Denmark, at EASD 2020.

“People with diabetes have an increased risk and higher incidence of first falls and a higher incidence of fall-related injuries including fractures,” he pointed out.

While factors such as age and sex are non-modifiable, diabetes, the use of certain medications, and alcohol abuse could be modifiable risk factors for falls and fractures, he said.

“Gaining information on risk factors for falls could guide the management of diabetes treatment,” he continued. This could allow for improvement in treatment for patients at high risk of falls and fractures, he concluded.