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Meta-Analysis
. 2018 Sep;89(3):314-323.
doi: 10.1111/cen.13761. Epub 2018 Jul 3.

Fracture risk in young and middle-aged adults with type 1 diabetes mellitus: A systematic review and meta-analysis

Eleanor P Thong  1   2 , Madhuni Herath  1 , David R Weber  3 , Sanjeeva Ranasinha  2 , Peter R Ebeling  1   4 , Frances Milat  1   5 , Helena Teede  1   2
Affiliations
Meta-Analysis

Fracture risk in young and middle-aged adults with type 1 diabetes mellitus: A systematic review and meta-analysis

Eleanor P Thong et al. Clin Endocrinol (Oxf). 2018 Sep.

Abstract

Background: Type 1 diabetes mellitus (T1DM) is associated with skeletal fragility. While previous meta-analyses have demonstrated an increased risk of fracture in individuals with T1DM, little is known about fracture risk in T1DM, in the absence of age-related confounders.

Aims: To determine the risk of fracture in young and middle-aged adults with T1DM aged 18-50 years old.

Design: Systematic review and meta-analysis.

Data sources: Ovid MEDLINE, PubMed, EMBASE, EBM reviews and relevant conference abstracts.

Study inclusion criteria: Studies of adults aged between 18-50 years with type 1 diabetes mellitus, with reported fracture outcomes.

Primary outcomes: Incident or prevalent fracture.

Results: Six studies were included in the meta-analysis. A total of 1724 fractures occurred in 35 925 patients with T1DM and 48 253 fractures occurred in 2 455 016 controls. RR for all fractures was 1.88 (95% CI 1.52-2.32, P < .001). Fifty-six hip fractures occurred among 34 707 patients with T1DM and 594 hip fractures occurred in 2 295 177 controls. The RR of hip fractures was 4.40 (95% CI 2.58-7.50, P < .001). Females and males with T1DM had a RR of 5.79 (95% CI 3.55-9.44, P < .001) and 3.67 (95% CI 2.10-6.41, P < .001), respectively.

Conclusions: In the absence of age-related comorbidities, fracture risk remains significantly elevated in young and middle-aged adults with T1DM. Younger age does not mitigate against hip fracture risk in T1DM, and health professionals need to be aware of this risk. Further studies are needed to evaluate the mechanisms of fracture in T1DM.

Keywords: bone metabolism; fracture; hip fracture; type 1 diabetes mellitus; young adults.

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Conflict of interest statement

CONFLICT OF INTEREST

Nothing to declare.

Figures

FIGURE 1
FIGURE 1
Flowchart of study selection. Diagram adapted from Moher et al. (2009)
FIGURE 2
FIGURE 2
All fractures
FIGURE 3
FIGURE 3
Hip fractures
See this image and copyright information in PMC

References

    1. Reginster JY, Burlet N. Osteoporosis: a still increasing prevalence. Bone. 2016;38:S4–S9. - PubMed
    1. Hough FS, Pierroz DD, Cooper C, Ferarri SL. Mechanisms in endocrinology: mechanisms and evaluation of bone fragility in type 1 diabetes mellitus. Eur J Endocrinol. 2016;174:R127–R138. - PubMed
    1. Vestergaard P Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes - A meta- analysis. Osteoporos Int. 2017;18:427–444. - PubMed
    1. Shah VN, Harrall KK, Shah CS, et al. Bone mineral density at femoral neck and lumbar spine in adults with type 1 diabetes: a meta- analysis and review of the literature. Osteoporos Int. 2017;28:2601–2610. - PubMed
    1. Roggen I, Gies I, Vanbesien J, Louis O, De Schepper J. Trabecular bone mineral density and bone geometry of the distal radius at completion of pubertal growth in childhood type 1 diabetes. Horm Res Pediat. 2013;79:68–74. - PubMed

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