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Diabetes and endocrinology
Research
Diabetes mellitus and the risk of fractures at specific sites: a meta-analysis
  1. Hao Wang,
  2. Ying Ba,
  3. Qian Xing,
  4. Jian-Ling Du
  1. Department of Endocrinology, First Affiliated Hospital of Dalian Medical University, Dalian, China
  1. Correspondence to Hao Wang; wanghaodl{at}126.com

Abstract

Objective Diabetes mellitus (DM) is associated with an increased fracture risk; however, the impact of DM and subsequent fracture at different sites and the associations according to patient characteristics remain unknown.

Design Meta-analysis

Data sources The PubMed, EMBASE and Cochrane Library databases were searched from inception to March 2018.

Eligibility criteria We included prospective and retrospective cohort studies on the associations of DM and subsequent fracture risk at different sites.

Data extraction and synthesis Two authors independently extracted data and assessed the study quality. Relative risks (RRs) with 95% CIs were calculated using a random-effects model, and the heterogeneity across the included studies was evaluated using I2 and Q statistics.

Results Overall, DM was associated with an increased risk of total (RR: 1.32; 95% CI 1.17 to 1.48; p<0.001), hip (RR: 1.77; 95% CI 1.56 to 2.02; p<0.001), upper arm (RR: 1.47; 95% CI 1.02 to 2.10; p=0.037) and ankle fractures (RR: 1.24; 95% CI 1.10 to 1.40; p<0.001), whereas DM had no significant impact on the incidence of distal forearm (RR: 1.02; 95% CI 0.88 to 1.19; p=0.809) and vertebral fractures (RR: 1.56; 95% CI 0.78 to 3.12; p=0.209). RR ratios suggested that compared with patients with type 2 DM (T2DM), patients with type 1 DM (T1DM) had greater risk of total (RR: 1.24; 95% CI 1.08 to 1.41; p=0.002), hip (RR: 3.43; 95% CI 2.27 to 5.17; p<0.001) and ankle fractures (RR: 1.71; 95% CI 1.06 to 2.78; p=0.029). Although no other significant differences were observed between subgroups, the association of DM with upper arm or ankle, vertebrae and total fracture differed according to sex, study design and country, respectively.

Conclusions Patients with DM had greater risks of total, hip, upper arm and ankle fractures, with T1DM having a more harmful effect than T2DM.

  • diabetes mellitus
  • fracture
  • meta-analysis

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/bmjopen-2018-024067

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    Footnotes

    • Patient consent for publication Not required.

    • Contributors J-LD and HW contributed to the conception and design. HW, YB and QX contributed to acquisition, analysis and interpretation of data. HW and J-LD were involved in drafting or critical revision of the manuscript. All the authors approved the final version.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement Extra data can be accessed via the Dryad data repository at http://datadryad.org/with the doi:10.5061/dryad.nf15dn8.