Research from Sweden has shed new light on why individuals with type 2 diabetes are at a higher risk of fractures. Contrary to previous beliefs that higher bone density might protect against fractures, the study reveals that the real issue may be reduced physical function, particularly in older women.

Published in JAMA Network Open, the study highlights that while people with type 2 diabetes often have higher bone density, this does not translate into lower fracture rates. Instead, the increased fracture risk is linked to poorer physical health and functionality.

The research, led by Dr. Mattias Lorentzon from Gothenburg University and Sahlgrenska University Hospital, examined 294 women with type 2 diabetes aged 75-80 and compared them with 2,714 women without diabetes. The study found that women with diabetes had significantly lower physical performance scores. They showed slower movement, less strength, and poorer balance compared to their non-diabetic counterparts.

Dr. Lorentzon explained, “Our study clearly shows that older women with type 2 diabetes have much worse physical function but no different or better bone characteristics. This suggests that the increased risk of fractures is due to falls resulting from poor physical function.”

The researchers noted that women with type 2 diabetes had 4.4% higher bone density in the hip and similar increases in the femoral neck and lumbar spine. However, their physical performance was notably impaired. For instance, participants with diabetes had a 19.2% lower score on the Physical Activity Scale for the Elderly and demonstrated poorer results on balance and mobility tests.

Furthermore, the study highlighted that diabetes medications could influence bone health. Women on insulin had a 71% increased risk of fractures, while those using oral diabetes medications had a 27% higher risk. Despite having higher bone density, these medications did not prevent the decline in physical function.

Dr. Yoshua Quinones, an internist who was not involved in the study, noted, “Type 2 diabetes often leads to increased bone density but also a higher risk of fractures due to factors like high blood sugar levels and inflammation, which can weaken bones and affect balance.”

The findings emphasize the need for improved physical function in diabetes management. “Improving physical function may reduce the fracture risk in patients with type 2 diabetes,” Dr. Lorentzon suggested. The study underscores the importance of addressing physical health alongside managing diabetes to prevent falls and fractures in this vulnerable population.