Effect of intensive therapy on the occurrence of bone fractures in patients with type 2 diabetes

This study examined the effects of intensive therapy on the occurrence of bone fractures in patients with type 2 diabetes (T2D). The data showed that there was no increased risk of fractures with an intensive multifactorial intervention in these patients.

Patients with T2D are at increased risk of developing fractures. A fracture risk assessment (FRAX) score predicts the risk of developing fractures over 10 years. However, the scores may underestimate the occurrence of fractures in such patients. Fracture risk may be influenced by poor diabetes control, hypoglycemia (dangerously low blood glucose levels), and certain anti-diabetes drugs. Among these, thiazolidinediones (TZDs) such as pioglitazone (Actos), can affect fracture risk.

A recent study in Japan showed that fracture risk was higher in patients with a more intensive diabetes control. However, patients in this study were more commonly using TZDs in the intensive group. It is not clear whether a stricter diabetes control can influence the risk of fractures in patients with T2D.

This study included 2,540 patients with T2D. All patients had high blood pressure or abnormal blood lipid (fats) levels, or both. Patients received either conventional therapy or intensive therapy. Patients were followed up for an average of 7.8 years.

Patients treated with conventional therapy were 15% more likely to have an increased incidence of fractures compared to those treated with intensive therapy. However, this difference was not found statistically significant.

1,043 men and 670 women had a risk assessment for major osteoporosis. The FRAX score was not associated with an increased risk of fractures in men. A history of smoking in men doubled the risk of major osteoporotic fractures.

The FRAX score was a good predictor of fracture risk in women. 5.8% of women reported major osteoporotic fractures. Pioglitazone use increased the FRAX score in women after 1 year.

This study showed that a multifactorial intervention that uses intensive therapy for T2D is not associated with an increased risk of fractures.

Additional studies are needed to consider different genetic backgrounds. Under-reporting of fractures by patients is a possibility due to self-reporting. The effect of osteoporosis medications was not considered in the study. FRAX score did not represent the entire population.

If you have questions about intensive therapy for T2D and risk of fractures, please ask your doctor.