New research shows that patients who have higher obesity, diabetes risk and diabetes complications may have a greater likelihood of experiencing a greater fracture due to blood clots than patients living with lower obesity, diabetes risks or risk factors for being overweight and unhealthy for diabetes.
Bones fracture is the leading cause of death in the United States. By the time a patient sees a clinical specialist, their bone may already be bruised and broken. A significant increase in fracture risk can indicate poor health, meaning that patients may be at greater risk for bone health-related complications—such as falls and fractures.
“We need to understand what drives bone health that otherwise may not be apparent,” said Sharon Finke, a James B. Finger, Jr. Fellow in Statistics and Health Policy at the Hoover Institution at the University of California, San Diego. “We’d like to examine whether lifestyle factors that are prevalent outside of medicine—talking, physical activity and diet—may be having a direct effect on bone health—for example, having the reverse effect of decreasing bone health.”
Finke and colleagues determined a correlation between obesity, type 2 diabetes, and age-related bone thinning, having calcified spondyloarthritis, osteopenia and hollowing of the hip, and the risk of fracture in adults. Data was collected from 7,489 adult patients in the Veterans Aging Cohort Study who were followed as outpatient groups between 2000 and 2010. The researchers used a data-driven linear regression model to examine associations between obesity, type 2 diabetes, type 2 and non-type 2 diabetes, hypertension, osteopenia, young-onset type 2 diabetes and total fractures. The model included body mass index, waist circumference and body-mass index as non-contributing factors.
Among the body mass index cases, 1 in 15 individuals were obese and 1 in 4 were obese with a low-to-moderate body-mass index (BMI-min), low-BMI-quint, overweight-quint and no change in BMI-min. When BMI-min was adjusted for type 2 diabetes, multivariable models were superior to single model comparisons. A sensitivity analysis showed that the best estimate of BMI-min for non-obese individuals was 95 kg/m2 higher for those with type 2 diabetes versus those without. Women had a lower BMI-min when obese than those of any of the weight-matched multi-matched controls (BMI-miles (BMI-min = 85–99 kg/m2), age 60 and younger (BMI-min = 83–89 years) and men (BMI-min = 81–89 years).
Women in the obese group had more bone-stiffening erythrocytes (endothetic cells) in their femur when compared with the non-obese group. When obesity was accounted for, these erythrocytic cells had increased erythrocytic cell numbers and increased osteophytes in their kneecap area.
Researchers also have examined the effects of lifestyle factors associated with bone health—including promoting physical activity, diet and alcohol intake—on bone health in patients with obesity. Diabetes mellitus was further associated with higher bone mineral density (BMD) (CBM) and decreased collagen and laminin densitometry in a sensory nerve. These associations were strengthened by adjusting for smoking, alcohol intake, smoking habits, drug use and osteoporosis.