Older women with type 2 diabetes, despite having higher bone mineral density, may have a higher risk of experiencing fractures primarily caused by impaired physical function, according to a recent study.

In the study, published in JAMA Network Open, investigators identified an association between type 2 diabetes (T2D) and an increased risk of fractures among 3,008 older women, including 294 with T2D. Conducted in the Gothenburg area from 2013 to 2016, the study found that women with T2D had higher bone mineral density (BMD) and better bone microarchitecture compared with those without diabetes. Despite these skeletal characteristics, women with T2D demonstrated poorer physical function, characterized by slower gait speed, reduced grip strength, and diminished mobility.

Women with T2D exhibited BMD measurements that were 4.4% greater at the total hip, 4.9% greater at the femoral neck, and 5.2% greater at the lumbar spine when compared with women without diabetes. Additionally, women with T2D showed a 7.4% increase in cortical area, a 1.3% higher cortical density, and an 8.7% greater trabecular bone volume fraction at the tibia compared with the control group.

However, the investigators found that the elevated fracture risk in women with T2D was primarily associated with impaired physical function rather than differences in skeletal characteristics. Women with T2D demonstrated 9.7% weaker grip strength, 9.9% slower walking speed, and a 13.9% longer time to complete the timed up-and-go test compared with women without T2D. Over a median follow-up of 7.3 years, a total of 1,071 fractures were recorded, including 853 major osteoporotic fractures and 232 hip fractures.

Women with T2D who were on insulin therapy faced a 71% higher risk of experiencing any fracture and an 89% higher risk of major osteoporotic fractures compared with the control group. Furthermore, women with T2D engaged in 19.2% less physical activity and had a higher occurrence of comorbidities, including stroke, ischemic heart disease, and heart failure compared with women without T2D.

Although the bone material strength index was similar between women with and without T2D, physical performance metrics such as the timed up-and-go and 10-meter walk tests were significantly worse in the T2D group. These results suggested that addressing physical function may be essential in reducing fracture risk in older women with T2D.

Full disclosures can be found in the published study.