Diabetes tied to increased risk of hidden spinal fractures

People with type 2 diabetes are more likely than others to develop spinal fractures that sometimes have no obvious symptoms but are tied to increased risk of future broken bones, a research review suggests.

The analysis focused on so-called vertebral fractures, also known as compression fractures, that happen when bones in the spine weaken and crumple, often in the lower back. These fractures can be caused by injuries or by osteoporosis and may have few symptoms, but they can lead to problems like severe chronic pain or reduced height.

The current study included data from 15 prior studies with a total of 852,702 men and women. Overall, people with type 2 diabetes were 35 percent more likely than those without the disease to have vertebral fractures, the analysis found.

And individuals with both diabetes and vertebral fractures were more than twice as likely as others to experience broken bones elsewhere in the body.

“Currently, there are no specific guidelines for the assessment of fracture risk or treatment of osteoporosis in individuals with type 2 diabetes,” Fjorda Koromani of Erasmus University Medical Center in Rotterdam, the Netherlands, and colleagues write in Diabetes Care.

“Based on our findings, we suggest that individuals with type 2 diabetes should be systematically assessed for the presence of vertebral fractures,” they write.

Moreover, when people with diabetes do have vertebral fractures, the study team advises, this would be a good reason to start treatment for osteoporosis to help prevent future broken bones.

Type 2 diabetes has long been linked to an increased risk of complications like heart attacks and strokes, nerve damage, kidney failure, vision deterioration and premature death. People with diabetes also have an increased risk of fractures of the hip and other broken bones, the researchers note.

People with diabetes in the study who didn’t have vertebral fractures still had a 94% higher risk of broken bones compared to those without diabetes. And people with vertebral fractures without diabetes had a 73% higher risk of broken bones.

When people had both diabetes and vertebral fractures, they were 2.4 times more likely than those with neither condition to experience broken bones.

People with both diabetes and vertebral fractures were also more likely to die prematurely than others, with the greatest risk seen in heavier people, particularly obese men.

One limitation of the results is that the smaller studies included in the analysis didn’t examine in detail how the risk of broken bones or premature death varied based on body mass.

Another drawback is that researchers lacked data on what type of treatment people with diabetes used, making it impossible to determine whether diabetes medication influenced the outcomes.

Still, the results suggest that vertebral fractures may represent an underrecognized health risk for people with diabetes, the study authors conclude.

“Notoriously, presence of vertebral fractures in patients with type 2 diabetes also constitutes a call for attention to potentially frail individuals at higher risk of mortality than that expected from type 2 diabetes alone,” the researchers write.