Prior Falls, Low Grip Strength, and Elevated HbA1c Predict Fractures in Older Adults With Type 2 Diabetes

Older woman who has fallen on the floor
Weak elderly woman with walking stick waiting for help after breathlessness attack .Elderly woman fell on the floor.
Researchers identified the clinical characteristics of fragility fractures among older adults with type 2 diabetes, in the Framingham Heart Study.

Risk factors, including history of falls, low grip strength, and elevated hemoglobin A1c (HbA1c), are associated with an increased risk for fractures among older adults with type 2 diabetes (T2D), according to study results published in Diabetes Care.

Previous studies have shown that T2D is associated with an increased risk for fractures, but the mechanisms have not been well understood and there are limited data on the risk factors for fractures in these patients.

The objective of the prospective study was to identify risk factors for fragility fractures in older adults with T2D.

Using data from the Framingham Original and Offspring cohorts, 793 patients with T2D (mean age, 70±10 years; 45% women) were included in the study.

During a mean follow-up of 4.5 years, a total of 106 first incident fracture events were reported, including 84 patients with 1 incident fracture event and 11 patients with 2 incident fracture events, over a period of 1437 observation intervals. The hip (27%) was the most common fracture site, followed by upper arm/shoulder (18%), foot/ankle/hip (17%), wrist/forearm (15%), and ribs (14%).

Data suggest that several well-established risk factors for fractures in the general population were associated with an increased fracture risk in older adults with T2D, including, older age (adjusted hazard ratio [aHR], 1.00; 1.44 [95% CI, 0.65-3.16]; and 2.40 [95% CI, 1.14-5.04] for <60; 60-69; and >70 years, respectively; P =.02); female sex (aHR, 2.23; 95% CI, 1.26-3.95); history of fracture (aHR, 2.05; 95% CI, 1.34-3.12); falls (aHRs, 1.00; 1.87 [95% CI, 0.82-4.28], and 3.29 [95% CI, 1.34-8.09] for no falls, 1 fall, and ≥2 falls, respectively; P =.03); and low grip strength (aHR, 0.82; 95% CI, 0.69-0.99 per 5-kg increase).

Risk for fracture was increased in older adults with T2D and elevated HbA1c, with a 2-fold increased risk (aHR, 2.10; 95% CI, 1.17-3.75) among patients with HbA1c between 6.50% and 7.49%, and a 29% increased risk (aHR, 1.29; 95% CI, 0.69-2.41) among those with HbA1c between 7.50% and 13.86% (P =.03).

Several well-established risk factors for fractures in the general population were not associated with increased fracture risk in older patients with T2D, including greater height, lower body mass index, lower bone mineral density (BMD), smoking, poor self-reported health, impairment in activities of daily living, dementia, and the use of antidepressant medications.

One of the limitations of the study was the low incidence of fractures in certain strata.

“Consideration of other factors beyond the current screening tool of BMD, including fracture and fall history, low grip strength, and poor glucose control, may allow for better disease management and health outcomes in older adults with [T2D],” the researchers concluded.

Disclosure: This research was supported by Radius Health, Inc. Please see the original reference for a full list of disclosures.


Dufour AB, Kiel DP, Williams SA, Weiss RJ, Samelson EJ. Risk factors for incident fracture in older adults with type 2 diabetes: the Framingham Heart Study. Diabetes Care. Published online May 17, 2021. doi:10.2337/dc20-3150

This article originally appeared on Rheumatology Advisor