Diabetes Mellitus and Risk of Skeletal Fracture

To the Editor: Heath et al. report in the September 4 issue that medial malleolar fractures occur with increased frequency in diabetic patients. The authors could find no other bones susceptible to increased risk of fracture (and, in fact, a significantly lower overall incidence of fractures was reported in their diabetic group [P<0.05]). We propose that obesity, which has been described as a risk factor for ankle fractures,¹ accounts for this susceptibility among the diabetic and pre-diabetic populations studied. The prevalence of obesity among patients with adult-onset diabetes is as high as 30 to 50 per cent²; in the.