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Risk of Fracture in Type 2 Diabetes Mellitus Patients: Meta-Analysis of Observational Studies

      Objectives

      Patients with type 2 diabetes mellitus (T2DM) display a unique skeletal phenotype with either normal or more frequently increased, bone mineral density and impaired structural and geometric properties. Alterations in bone material properties seem to be the predominant defect leading to increased bone fragility. A systematic review and meta-analysis of observational studies is conducted to assess the association between T2DM and fracture risk.

      Methods

      A systematic literature search was performed in Medline and EMBASE databases. “Abstracts” from annual scientific meeting of various diabetes and bone and mineral societies were also searched to identify relevant studies. Studies reporting fracture risk in subjects with T2DM in comparison with subjects without diabetes were included. Heterogeneity was calculated by performing I2 statistics. Summary relative risk (RR) estimates and 95% confidence intervals (CIs) were calculated using random-effects model.

      Results

      Twelve studies met the inclusion criteria reporting 25,848 fracture events among 6,12,748 subjects without diabetes (4.2 %) and 8570 fracture events among 2,12,011 subjects with T2DM (4.0 %). The pooled relative risk (RR) of any fracture in subjects with T2DM was 0.91 (95% CI 0.75 – 1.11, p=0.375). The pooled RR for any fractures in women with T2DM was 0.907 (95% CI 0.735- 1.118, 10 studies) compared to subjects without diabetes. The pooled RR for any fractures in men with T2DM was 0.868 (95% CI 0.738 to 1.022) compared to subjects without diabetes. Sensitivity analysis demonstrated stability of result after removing outliers. No publication bias was observed on visual analysis of funnel plot.

      Conclusions

      Our meta-analysis suggests that patients of T2DM are not at increased risk of incidence of fractures as compared to non diabetic subjects.