Papaioannou Ioannis, Pantazidou Georgia, Kokkalis Zinon, Georgopoulos Neoklis, Jelastopulu Eleni
Orthopedics, General Hospital of Patras, Patras, GRC.
Otolaryngology - Head and Neck Surgery, General Hospital of Patras, Patras, GRC.
Cureus. 2021 Apr 16;13(4):e14514. doi: 10.7759/cureus.14514.
Diabetes mellitus type 2 (T2DM) is an emerging public health issue with high prevalence rates among older adults while fragility fractures constitute a significant public health burden with a great impact. Osteoporosis is the most important metabolic bone disease in patients with diabetes mellitus. Based on current evidence, individuals with T2DM are more vulnerable to fragility fractures than their non-diabetic counterparts, although until now, there aren't any systematic reviews or meta-analyses concerning the impact of T2DM on the risk of fragility fractures in elderly patients. The aim of this study is to fill this gap in the current literature concerning this specific patient group. Literature in PubMed and Google Scholar was searched for relevant articles published up to January 2021. The keywords used were: elderly, diabetes mellitus type 2, and fragility fractures. Among the 180 articles retrieved, only four full-text articles were eligible and, finally, two studies (one population-based cohort study and one cross-sectional study) met the inclusion criteria for the review. Although we identified 15 records through the manual research, finally 17 records were included in the current review. The records retrieved from the manual research were 11 prospective cohort studies, two population-based studies, one prospective observational study, and one retrospective cohort study. The author's name, year of publication, country, type of study, and number of patients were reported. According to this systematic review, there is almost consensus about the increased prevalence of all kinds of fragility fractures and especially low-energy hip fractures among elderly patients with T2DM compared with their counterparts without T2DM while there is relative controversy concerning non-vertebral fractures. Vertebral fractures in the elderly with T2DM require further evaluation because the results from cohort studies are more conflicting. Finally, insulin usage can increase the possibility of fragility fractures and can even double this risk. Bone fragility should be recognized as a new complication of T2DM, especially in elderly patients, due to several additional aggravating factors such as senile osteoporosis, severe vitamin D deficiency, presence of many comorbidities, increased possibility of insulin usage, and the presence of diabetes-related complications (mainly neuropathy and retinopathy). Clinicians who treat these patients should be aware of the special diagnostic and therapeutic approaches concerning these patients.
2型糖尿病（T2DM）是一个新出现的公共卫生问题，在老年人中患病率很高，而脆性骨折构成了一个重大的公共卫生负担，影响巨大。骨质疏松症是糖尿病患者中最重要的代谢性骨病。根据现有证据，与非糖尿病患者相比，T2DM患者更容易发生脆性骨折，尽管到目前为止，尚无关于T2DM对老年患者脆性骨折风险影响的系统评价或荟萃分析。本研究的目的是填补当前文献中关于这一特定患者群体的空白。检索了PubMed和谷歌学术中截至2021年1月发表的相关文章。使用的关键词为：老年人、2型糖尿病和脆性骨折。在检索到的180篇文章中，只有4篇全文文章符合条件，最终，两项研究（一项基于人群的队列研究和一项横断面研究）符合综述的纳入标准。尽管我们通过手工检索确定了15条记录，但最终17条记录被纳入本综述。从手工检索中获得的记录包括11项前瞻性队列研究、2项基于人群的研究、1项前瞻性观察性研究和1项回顾性队列研究。报告了作者姓名、发表年份、国家、研究类型和患者数量。根据这项系统评价，与无T2DM的老年患者相比，T2DM老年患者各种脆性骨折尤其是低能量髋部骨折的患病率增加几乎已达成共识，而非椎体骨折则存在相对争议。T2DM老年患者的椎体骨折需要进一步评估，因为队列研究的结果更具冲突性。最后，使用胰岛素会增加脆性骨折的可能性，甚至会使这种风险加倍。由于一些额外的加重因素，如老年性骨质疏松症、严重维生素D缺乏、多种合并症的存在、胰岛素使用可能性增加以及糖尿病相关并发症（主要是神经病变和视网膜病变）的存在，骨脆性应被视为T2DM的一种新并发症，尤其是在老年患者中。治疗这些患者的临床医生应了解针对这些患者的特殊诊断和治疗方法。
