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Meta-Analysis
. 2020 Aug:137:115457.
doi: 10.1016/j.bone.2020.115457. Epub 2020 May 29.

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

Tatiane Vilaca  1 , Marian Schini  2 , Susan Harnan  3 , Anthea Sutton  4 , Edith Poku  5 , Isabel E Allen  6 , Steven R Cummings  7 , Richard Eastell  8
Affiliations
Free article
Meta-Analysis

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

Tatiane Vilaca et al. Bone. 2020 Aug.
Free article

Abstract

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; Meta-analysis; Non-vertebral fracture.

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Conflict of interest statement

Declaration of competing interest TV received grant funding from Amgen Inc. and personal support from Conselho Nacional de Desenvolvimento Científico e Tecnológico - CNPq- Brazil. MS received grant funding from Amgen Inc. and personal fees from the Centre For Integrated Research Into Musculoskeletal Ageing (CIMA) and Osteoporosis 2000. SH received grant funding from Amgen Inc. EP received grant funding from Amgen Inc. AS received grant funding from Amgen Inc. SC received consultancy and grant funding from Amgen Inc. IA received grant funding from Amgen Inc. RE received consultancy funding from Immunodiagnostic Systems, Roche Diagnostics, GSK Nutrition, FNIH, Mereo, Lilly, Sandoz, Nittobo, Abbvie, Samsung, Haoma Medica and grant funding from Nittobo, Immunodiagnostic Systems, Roche Diagnostics, Amgen Inc. and Alexion.

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