Older adults with diabetes are known to have increased fracture risk, although whether diabetes preferentially affects specific femoral fracture sites remains uncertain. A nationwide registry analysis published in Diabetes Care evaluated the association of type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) with subtrochanteric and femoral shaft (ST/FS) fractures compared with hip fractures in adults aged 65 years and older.

The study used Danish national registry data collected between 1997 and 2021 to estimate incidence rates (IRs), incidence rate ratios (IRRs), and fracture-site associations among individuals with T1DM, T2DM, and no diabetes.

Findings

• T1DM was associated with significantly higher incidence of ST/FS fractures (IRR 2.53; P < 0.001) and hip fractures (IRR 2.17; P < 0.001) compared with no diabetes.
• T2DM was also associated with a modestly higher incidence of ST/FS fractures (IRR 1.08; P = 0.002) and hip fractures (IRR 1.06; P = 0.008).
• After age adjustment, only T1DM remained significantly associated with increased fracture incidence.
• Adjusted analyses showed higher odds of ST/FS fractures relative to hip fractures in both T1DM (OR 1.14; P = 0.002) and T2DM (OR 1.05; P = 0.008).

T1DM was associated with substantially higher incidence of femoral fractures in older adults, while both T1DM and T2DM showed modestly greater susceptibility to ST/FS fractures compared with hip fractures.