BONE MINERAL DENSITY IN ELDERLY HIP FRACTURE PATIENTS: THE DUAL BURDEN OF TYPE 2 DIABETES AND CHRONIC KIDNEY DISEASE

Introduction:

Diabetes mellitus (DM) and chronic kidney disease (CKD) are common medical conditions among the elderly and have been shown to increase the risk of bone fractures due to their negative impact on bone quality. Recent data demonstrates the association of bone mineral density (BMD) with fragility fractures in patients with CKD. When DM and CKD occur in combination, the negative impact on BMD may be greater due to the complex interplay between the two conditions. Given that T2DM is common in an Asian population, it is important for healthcare providers to be aware of the potential impact of DM and CKD on bone health and to implement appropriate interventions to reduce the risk of bone fractures in this population. This study aims to investigate potential differences in the impact of T2DM and CKD on BMD in a cohort of elderly patients with fragility hip fracture when these conditions occur alone versus when they occur in combination. We also investigate the relationship of worsening HBA1c to BMD in the groups with and without CKD . 

Methods:

A cross-sectional study involving 571 elderly patients (aged ≥65 years) with fragility hip fractures was conducted at a tertiary care hospital between June 2014 and June 2016. Patients were categorized into four groups based on DM and CKD presence. Bone mineral density (BMD) at the femoral neck was measured using dual-energy X-ray absorptiometry (DXA) scan. Statistical analysis included ANOVA with Bonferroni correction.

Results:

The mean age was 79.5 ± 7.3 years, with females comprising 70.6%. Group 2 (No CKD with Diabetes present) exhibited significantly higher T-scores than Group 1 (No CKD or Diabetes). Patients with DM had higher BMD, with an increase of 0.2 compared to those without DM and CKD. Surprisingly, Group 4 (CKD present DM present) did not worsen T-scores. Higher HbA1c levels were positively associated with BMD, but this was lost in concurrent CKD, Fig 1.

Conclusions:

Patients with DM had higher T-score, and the combination of CKD and DM did not worsen T-scores. However, the positive association between higher HbA1c and BMD was nullified in concurrent CKD. These findings emphasize the need for tailored interventions to mitigate fracture risk in elderly populations with DM and CKD.

 Limitations: This study has several limitations, including its cross-sectional design, which does not allow for causal inference. Additionally, the study population was limited to elderly patients with fragility hip fracture 

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.