Forensic medical aspects of harm grading in bone fractures associated with diabetes mellitus and osteoporosis: an experimental study

BACKGROUND: Skeletal fractures are one of the most common consequences of mechanical injury in forensic medicine. Diabetes mellitus and osteoporosis can affect bone microarchitecture, leading to its mechanical failure. These conditions should be considered by forensic pathologists when grading harm and determining the type and mechanism of injury.

AIM: The study aimed to evaluate bone strength in diabetes mellitus and osteoporosis to improve forensic medical methodology for harm grading in these conditions.

METHODS: This was an experimental single-center, selective, controlled, non-randomized, open-label study. Rats were used to model fractures associated with osteoporosis and type 2 diabetes mellitus. A total of 24 mongrel female rats weighing 155–160 g were selected. The rats were divided into four groups of six animals: group 1, intact controls; group 2, rats with induced obesity and hyperglycemia, mimicking type 2 diabetes mellitus; group 3, rats with bone changes corresponding to stages III–IV of human osteoporosis, induced by sequential tibial osteotomy; group 4, rats subjected to identical osteotomy procedures, complicated by obesity and hyperglycemia. These were conditions that aggravated bone loss. The statistical data was processed using Microsoft Office Excel 2016. The mean value and standard error were calculated for each group. A two-tailed Student’s t-test was used at a significance level of p < 0.05 to compare the intact animal group with one of the experimental groups.

RESULTS: Diabetes mellitus makes bones more susceptible to bending and twisting deformities. Osteoporosis is characterized by a greater decrease in bone tissue strength and elasticity. Mineral and organic bone components were both affected. The most severe changes in bone microarchitecture occur in the combination of diabetes mellitus and osteoporosis.

CONCLUSION: Systemic diseases such as osteoporosis and diabetes mellitus have been shown to directly affect bone strength. They increase bone fragility and pose a high risk of fracture, especially during physical activity. Quantitative data from an animal experiment shows that bone strength decreases substantially in cases of osteoporosis and diabetes mellitus associated with severe bone destruction. These data can be extrapolated to humans and used as evidence that the resulting fractures are pathologic ones or that they occur with substantially less force than similar fractures in patients without comorbidities.