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Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies

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Abstract

Summary

In this meta-analysis, evidence of an association between type 2 diabetes mellitus (T2DM) and low-energy fractures has been evaluated including 12 observational studies. The results suggested that T2DM patients had an enhanced risk of low-energy fractures.

Introduction

Type 1 diabetes mellitus (T1DM) patients have been shown to be at enhanced risk of fracture injury, but less is known about low-energy fractures among patients with T2DM.

Methods

We performed a meta-analysis of 12 observational studies identified in Medline and EMBASE that included 938,742 participants, including 30,827 low-energy fracture cases. The incidence rate ratios (IRRs) of low-energy fractures were determined using a random-effects model.

Results

The IRRs of low-energy fracture for men and women were 1.37 (95% confidence interval [CI], 0.94–2.00; p = 0.096) and 1.22 (95% CI, 1.09–1.35; p = 0.000), respectively, and the overall IRR was 1.23 (95% CI, 1.12–1.35; p = 0.000). The IRRs for hip and vertebral fractures were 1.08 (95% CI, 1.02–1.15; p = 0.007) and 1.21 (95% CI, 0.98–1.48; p = 0.073), respectively. The IRRs of low-energy fracture in case-control, prospective, retrospective, and cross-sectional studies were 1.18 (95% CI, 0.81–1.72; p = 0.380), 1.17 (95% CI, 1.05–1.32, p = 0.006), 1.15 (95% CI, 1.02–1.29; p = 0.020), and 1.60 (95% CI, 1.21–2.12; p = 0.001), respectively. The IRRs of low-energy fracture for less than 5 years, 5 to 10 years, and more than 10 years were 1.30 (95%, CI 1.13–1.50; p = 0.000), 1.05 (95% CI, 1.03–1.08; p = 0.000), and 1.19 (95% CI, 1.00–1.41; p = 0.049), respectively.

Conclusions

Patients with T2DM had a greater risk of low-energy fracture especially of the hip, compared with that in non-diabetic subjects. However, since according to our funnel plot a publication bias may be present and due to study heterogeneity as well as the limited number of publications, the finding needs to be interpreted with caution.

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Author notes

  1. Pu Jia and Li Bao contributed equally to this work.

Authors and Affiliations

  1. Department of Orthopedics, Beijing Friendship Hospital, Capital Medical University, No. 95 Yong’an Road, Xicheng District, Beijing, 100050, China

    P. Jia, L. Bao, H. Chen, F. Feng, J. Li & H. Tang

  2. Department of Endocrinology, Beijing Tongren Hospital, Capital Medical University, No. 1 Dongjiaominxiang, Dongcheng District, Beijing, 100730, China

    J. Yuan & W. Liu

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  1. P. Jia
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Jia, P., Bao, L., Chen, H. et al. Risk of low-energy fracture in type 2 diabetes patients: a meta-analysis of observational studies. Osteoporos Int 28, 3113–3121 (2017). https://doi.org/10.1007/s00198-017-4183-0

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  • DOI: https://doi.org/10.1007/s00198-017-4183-0

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