The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes:​ a systematic review and meta-analysis update

Vilaca, Tatiane; Schini, Marian; Harnan, Susan; Sutton, Anthea; Poku, Edith; Allen, Isabel E.; Cummings, Steven R.; Eastell, Richard

Affiliations

¹Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK

²School of Health and Related Research (ScHARR), University of Sheffield, UK

³University of California, San Francisco, USA

⁴San Francisco Coordinating Center, Sutter Health, University of California, San Francisco, USA

Abstract and keywords

Background: Diabetes is associated with increased fracture risk but we do not know what affects this risk. We investigated the risk of hip and non-vertebral fractures in diabetes and whether this risk was affected by age, gender, body mass index, diabetes type and duration, insulin use and diabetic complications.

Methods: We selected a previously published review to be updated. MEDLINE, Embase and Cochrane databases were searched up to March 2020. We included observational studies with age and gender-adjusted risk of fractures in adults with diabetes compared to adults without diabetes. We extracted data from published reports that we summarised using random effects model.

Findings: From the 3140 records identified, 49 were included, 42 in the hip fracture analysis, reporting data from 17,571,738 participants with 319,652 fractures and 17 in the non-vertebral fracture review, reporting data from 2,978,487 participants with 181,228 fractures. We found an increase in the risk of fracture in diabetes both for hip (RR 4.93, 3.06–7.95, in type 1 diabetes and RR1.33, 1.19–1.49, in type 2 diabetes) and for non-vertebral fractures (RR 1.92, 0.92–3.99, in type 1 and RR 1.19, 1,11–1.28 in type 2). At the hip, the risk was higher in the younger population in both type 1 and type 2 diabetes. In those with type 2 diabetes, longer diabetes duration and insulin use was associated with an increased risk. We did not investigate the effect of bone density, falls, anti-diabetic drugs and hypoglycemia.

Conclusion: Diabetes is associated with an increase in both hip and non-vertebral fracture risk.

Keywords: Diabetes; Fracture risk; Hip fracture; Non-vertebral fracture; Meta-analysis

Links

DOI: 10.1016/j.bone.2020.115457

PubMed: 32480023

WoS: 000547005800057

History

Received: 2020-04-24

Revised: 2020-05-25

Accepted: 2020-05-25

Online: 2020-05-29

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