Diabetes increases hip fracture risk by 20% in the elderly

With the prevalence of diabetes having increased by nearly 70% in Ontario in the last decade, findings from a new Institute for Clinical Evaluative Sciences (ICES) study which show that diabetes is associated with a 20% increased risk of hip fractures in elderly Ontarians have significant implications from a public health perspective.

“Although there is growing recognition of an association between diabetes and hip fractures, no study until now has examined the impact of diabetes on fractures in both men and women at a population level,” said Dr. Lorraine Lipscombe, ICES research fellow and lead author of the study.

In their study, investigators identified more than 197,000 Ontario residents who were 66 years of age and older with diabetes between 1994 and 1995, and then tracked the number of those admitted to hospital for a first hip fracture until March 31, 2003. Hip fracture rates were compared to those of over 400,000 age-matched Ontario residents without diabetes.

Diabetes was found to increase the risk of hip fracture by about 20% in both men and women. In addition, persons with diabetes were more likely to reside in the lowest income neighbourhoods, and were more likely to be prescribed at least one drug that increases falls or decreases bone mineral density (BMD). Individuals with diabetes were also more likely to have other illnesses and more physician visits, but were less likely to have had a BMD test compared to those without diabetes.

“With the dramatic rise in the prevalence of diabetes in Ontario, and given the fact that rates are expected to continue to increase with the current obesity epidemic, even a small increase in hip fracture risk among persons with diabetes will have a substantial public health impact,” said Dr. Lipscombe.

“In addition, the morbidity and mortality following hip fractures may be even greater with diabetics due to their higher rates of additional illnesses and disability.”

According to Dr. Lipscombe and her fellow investigators, “until there is further understanding of the mechanisms of diabetes and fractures, broad fracture risk assessment of all diabetes patients and enhanced prevention strategies in this population are warranted.”

The study, “The risk of hip fractures in older individuals with diabetes: a population-based study”, is published in the April 2007 issue of the journal Diabetes Care.

Author affiliations: ICES (Drs. Lipscombe, Booth, and Hawker); Department of Medicine (all authors) and Department of Health Policy, Management and Evaluation (Drs. Jamal, Booth and Hawker), University of Toronto; St. Michael’s Hospital (Drs. Jamal and Booth); Women’s College Hospital (Drs. Lipscombe and Hawker).

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

FOR FURTHER INFORMATION, PLEASE CONTACT:

• Julie Dowdie
• Media Relations Officer, ICES
• (416) 480-4780 or cell (416) 432-8143