There is an association with type 1 Diabetes (T1DM) and an increased risk of fractures described in the literature. This is likely multifactorial due to abnormal bone mineralisation and/or impacts on bone quality directly resulting from the disease itself, as well as the increased risk of falls associated with diabetes-related complications. While data is limited regarding the bone health of individuals with diabetes-related foot ulcers (DFU), available literature suggests that DFU may be a risk factor for low bone density and insufficiency fractures in this population. It has been noted that bone mineral density at the femur in this cohort is particularly affected. This may be due to interventions that improve wound healing including extended periods of offloading or alternatively may be secondary to the effects of inflammation on bone remodelling.
We identified four patients with T1DM and active DFU previously admitted between 2015 and 2021 to the Multidisciplinary Diabetes Foot Unit (MDFU) at a large Australian Tertiary Hospital who subsequently suffered neck of femur fractures.
The patients ranged from 39-57 years old, all of whom had suboptimal glycaemic control and documented microvascular complications including peripheral and autonomic neuropathy. In some cases, these complications were severe, including gastroparesis requiring parenteral feeding and previous below knee amputation resulting in being non-ambulatory. Additionally, all patients required some form of pressure offloading in the lead up to their fracture.
This case-series highlights a potential relationship between T1DM, active DFU and neck of femur fractures in a cohort of relatively young patients. While there is conflicting data relating duration of diabetes and diabetes control to fracture risk, our patient cohort had poorly controlled diabetes with concurrent microvascular complications. The association between type 1 diabetes, active DFU and future fracture risk warrants further exploration via longitudinal prospective studies.