Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2017 Apr 11:13:455-468.
doi: 10.2147/TCRM.S131945. eCollection 2017.

Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: a systematic review and meta-analysis

Ardeshir Moayeri  1 , Mahmoud Mohamadpour  2 , Seyedeh Fatemeh Mousavi  3 , Ehsan Shirzadpour  2 , Safoura Mohamadpour  3 , Mansour Amraei  4
Affiliations
Review

Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: a systematic review and meta-analysis

Ardeshir Moayeri et al. Ther Clin Risk Manag. .

Abstract

Aim: Patients with type 2 diabetes mellitus (T2DM) have an increased risk of bone fractures. A variable increase in fracture risk has been reported depending on skeletal site, diabetes duration, study design, insulin use, and so on. The present meta-analysis aimed to investigate the association between T2DM with fracture risk and possible risk factors.

Methods: Different databases including PubMed, Institute for Scientific Information, and Scopus were searched up to May 2016. All epidemiologic studies on the association between T2DM and fracture risk were included. The relevant data obtained from these papers were analyzed by a random effects model and publication bias was assessed by funnel plot. All analyses were done by R software (version 3.2.1) and STATA (version 11.1).

Results: Thirty eligible studies were selected for the meta-analysis. We found a statistically significant positive association between T2DM and hip, vertebral, or foot fractures and no association between T2DM and wrist, proximal humerus, or ankle fractures. Overall, T2DM was associated with an increased risk of any fracture (summary relative risk =1.05, 95% confidence interval: 1.04, 1.06) and increased with age, duration of diabetes, and insulin therapy.

Conclusion: Our findings strongly support an association between T2DM and increased risk of overall fracture. These findings emphasize the need for fracture prevention strategies in patients with diabetes.

Keywords: bone; diabetes mellitus; fractures; meta-analysis; osteoporosis; risk factors.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
Flowchart of the literature search. Abbreviations: IGT, impaired glucose tolerance; ISI, Institute for Scientific Information; T1DM, type 1 diabetes mellitus.
Figure 2
Figure 2
The results of meta-analysis of the association between type 2 diabetes mellitus and risk of hip fracture. Notes: Each square shows the study specific relative risk estimate. Square sizes are proportional to the weight assigned to the study in the meta-analysis and the horizontal line shows the related 95% CI. The diamond shows the summary relative risk estimate and its width represents the corresponding 95% CI. All statistical tests were two sided. Statistical heterogeneity between studies was assessed with Cochran’s Q test. Meta-analysis was performed by using a random effects method. Abbreviations: CI, confidence interval; ES, effect size.
Figure 3
Figure 3
The results of meta-analysis of the association between type 2 diabetes mellitus and risk of wrist fracture. Notes: Each square shows the study specific relative risk estimate. Square sizes are proportional to the weight assigned to the study in the meta-analysis and the horizontal line shows the related 95% CI. The diamond shows the summary relative risk estimate and its width represents the corresponding 95% CI. All statistical tests were two sided. Statistical heterogeneity between studies was assessed with Cochran’s Q test. Meta-analysis was performed by using a random effects method. Abbreviations: CI, confidence interval; ES, effect size.
Figure 4
Figure 4
The results of meta-analysis of association between type 2 diabetes mellitus and risk of overall fractures. Notes: Each square shows the study specific relative risk estimate. Square sizes are proportional to the weight assigned to the study in the meta-analysis and the horizontal line shows the related 95% CI. The diamond shows the summary relative risk estimate and its width represents the corresponding 95% CI. All statistical tests were two sided. Statistical heterogeneity between studies was assessed with Cochran’s Q test. Meta-analysis was performed by using a random effects method. Abbreviations: CI, confidence interval; ES, effect size.
Figure 5
Figure 5
Begg’s funnel plot for publication bias in the risk difference analysis. Abbreviation: RR, relative risk.
Figure 6
Figure 6
The meta-regression analysis of the relationship between the risk of factors in diabetic patients and the year of study. Abbreviations: CI, confidence interval; Coef, coefficient of variation; REML, restricted (or residual) maximum likelihood estimation; RR, relative risk.
See this image and copyright information in PMC

References

    1. Jackuliak P, Payer J. Osteoporosis, fractures, and diabetes. Int J Endocrinol. 2014;2014:820615. - PMC - PubMed
    1. de Waard EA, van Geel TA, Savelberg HH, Koster A, Geusens PP, van den Bergh JP. Increased fracture risk in patients with type 2 diabetes mellitus: an overview of the underlying mechanisms and the usefulness of imaging modalities and fracture risk assessment tools. Maturitas. 2014;79(3):265–274. - PubMed
    1. American Diabetes Association Diagnosis and classification of diabetes mellitus. Diabetes Care. 2012;35(Suppl 1):64–71. - PMC - PubMed
    1. Schwartz AV. Diabetes mellitus: does it affect bone? Calcif Tissue Int. 2003;73(6):515–519. - PubMed
    1. Milczarczyk A, Franek E. Osteoporosis and bone fractures in patients with diabetes mellitus. Diabet Dosw i Klin. 2008;8(2):63–67.

LinkOut - more resources