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Review
. 2020 Aug;11(8):1687-1694.
doi: 10.1007/s13300-020-00877-z. Epub 2020 Jul 10.

Why Do Falls and Lower Limb Fractures Occur More Frequently in the Diabetic Patient and How Can They Be Prevented?

David S H Bell  1 , Edison Goncalves  2
Affiliations
Review

Why Do Falls and Lower Limb Fractures Occur More Frequently in the Diabetic Patient and How Can They Be Prevented?

David S H Bell et al. Diabetes Ther. 2020 Aug.

Abstract

Due to primarily sarcopenia and hypoglycemia but also neuropathy, hypotension, analgesics and polypharmacy, there is an increased incidence of falls and hip fractures in both the type 1 and type 2 diabetic patient. Utilization of insulin, hypotensive drugs, analgesics and perhaps canagliflozin further increases the risk. Thiazolidinedione use may increase the risk of osteoporosis and fracture. Prolonged hyperglycemia resulting in cross-linking of collagen and advanced glycosylation end products alter the microarchitecture and increase bone fragility. Higher serum vitamin D levels seem to decrease the incidence of both falls and fractures. Following a hip fracture, mortality in the diabetic patient is increased largely because of cardiovascular events and pneumonia. Prevention of sarcopenia includes dietary therapy, vitamin D and testosterone replacement when appropriate.

Keywords: Aging; Diabetes; Falls; Fractures; Hypoglycemia; Neuropathy; Osteoporosis; Polypharmacy; Sarcopenia.

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References

    1. Zecevic AA, Salmoni AW, Speechley M, Vandervoort AA. Defining a fall and reasons for falling: comparisons among the views of seniors, health care providers, and the research literature. Gerontologist. 2006;46(3):367–376. - PubMed
    1. Rubenstein LZ, Josephson KR. Falls and their prevention in elderly people: what does the evidence show? Med Clin N Am. 2006;90(5):807–824. - PubMed
    1. Crenshaw JR, Bernhardt KA, Achenbach SJ, et al. The circumstances, orientations, and impact locations of falls in community-dwelling older women. Arch Gerontol Geriatr. 2017;73:240–247. - PMC - PubMed
    1. Horlings CG, van Engelen BG, Allum JH, Bloem BR. A weak balance: the contribution of muscle weakness to postural instability and falls. Nat Clin Pract Neurol. 2008;4(9):504–515. - PubMed
    1. Kanis JA, Oden A, McCloskey EV, et al. A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int. 2012;23(9):2239–2256. - PMC - PubMed

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