Diabetes Mellitus and Gender Have a Negative Impact on the Outcome of Hip Fracture Surgery—A Pilot Study

Abstract

Diabetes mellitus (DM) is associated with an elevated risk of post‐operative complications. The impact it has on patients living with DM following hip fracture surgery (HFS) is not completely understood and may represent a predictor of increased mortality. This study investigates the impact of DM, gender, American Society of Anaesthesiologists (ASA) grade, and fracture location, on the outcome of HFS in Ireland. The Hospital Inpatient Enquiry (HIPE) database records all fragility hip fractures within Galway University Hospital. Retrospective data collection was performed over a 3‐year period. Data collected included patient age, gender, date of HFS, anatomical fracture location, type of operation, ASA grade, DM status, and mortality. A database of 650 individuals was created including 461 females and 189 males, with an average group age of 80.2 ± 9.3 years. Results showed a significantly higher incidence of hip fractures in males with DM (19.57%) than females with DM (12.36%) (χ2 test, p = 0.020). Cox regression survival analysis indicated that DM status and ASA grade were the two main independent predictors of patient survival following HFS. Nevertheless, when examining the combined impact of gender and DM status on survival after HFS, results showed that survival post HFS differed significantly with gender and presence of DM (log‐rank test, p < 0.001), with males with DM performing worse than females with DM (p = 0.021) or males without DM (p = 0.001). This gender and disease‐associated outcome should prompt an early multi‐disciplinary team approach to the management of hip fractures in patients with DM. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 38:834‐842, 2020

The Role of Gender in the Onset, Development and Impact of Type 2 Diabetes Mellitus and Its Co-Morbidities

“…In terms of the role of gender in diabetic osteopathy, the disorder follows an opposite pattern to that seen in CVD and DKD. Poor bone health experienced primarily by women in the non-DM population as they age is largely absent in men, but in the context of DM there is an increased relative risk for men to experience, for example, hip fracture [149,156]. Fractures such as these are associated with high morbidity, especially functional limitations that results in loss of independence -physically and economically [178].…”

“…However, with an ageing population the absolute number of hip fractures is predicted to increase [139,140]. Compounding this challenge in managing orthopaedic health is the increased fracture risk in people living with T2DM [145][146][147][148][149]. Contrary to the osteoporotic context, this increase in fracture risk is despite generally increased BMD in the T2DM population [148,150,151].…”

“…The presence of T2DM also increases the odds ratio of poor fracture healing, resulting in a malunion or nonunion [154]. Hospital stay length and mortality following orthopaedic procedures are also increased in people with T2DM [149,155]. The increased risk of fracture is present in both women and men, with contradicting evidence regarding whether women or men are preferentially impacted in terms of fracture risk by T2DM, while worse outcomes post-operatively seem to be more prevalent in men [149,152,153,155,156], see Table 5.…”

“…Hospital stay length and mortality following orthopaedic procedures are also increased in people with T2DM [149,155]. The increased risk of fracture is present in both women and men, with contradicting evidence regarding whether women or men are preferentially impacted in terms of fracture risk by T2DM, while worse outcomes post-operatively seem to be more prevalent in men [149,152,153,155,156], see Table 5. Regardless, it is important that the increased risk of osteopathy in men with T2DM leads to appropriate intervention, where currently the emphasis of bone health is on women, in the T2DM context both women and men need to be considered.…”

Knowledge, Perceptions and Concerns of Diabetes-Associated Complications among Individuals Living with Type 1 and Type 2 Diabetes Mellitus

“…In particular, long-term exposure to the diabetic milieu elicits changes in bone metabolism and bone microarchitecture, which result in an increased risk of fracture and decreased healing rates [2,5,6]. Hip fractures are a significant basis of disability and mortality in middle-aged and older adults [7]. Previous studies have shown that both men and women with type 1 diabetes have low bone mineral density and an increased fracture risk [8][9][10].…”