A1c, Blood Pressure Fluctuations Predict Fracture Risk

COMMENTARY

A1c and Blood Pressure Fluctuations Predict Fracture Risk

Richard M. Plotzker, MD

Disclosures

May 18, 2022

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Not long after my own personal 40-year parts warranty expired, I sprinted a block to retrieve my daughter from her late-afternoon activity lest I incur the wrath of the activity director. My left ankle caught the curb edge, snapping the styloid process of my left fibula along with the fourth metatarsal — unknown to me until I got home, hobbled inside, and shrieked when my daughter inadvertently pushed that ankle against a table leg. A cast, crutches, and two doses of Tylenol #3 had me back on rounds the next morning.

Most others whose bones break don't fare as well. Despite advances in orthopedic surgery, the best option for fractures remains prevention.

Two studies appearing in the April 2022 issue of the Journal of Clinical Endocrinology & Metabolism move our knowledge of risk from the obvious — age, estrogen deficiency, and frailty — to common data from office encounters, namely glycemic control and blood pressure (BP). These studies don't project far enough into the future to register as fracture susceptibility, however.

A1c and Fractures

The first report is a multicenter US study that looked at correlations of A1cvalues as a risk-stratifying measurement. Of note, the authors are primarily computer scientists from a prominent engineering school, with a few physicians included.

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