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Diabetes mellitus and the risk of fractures at specific sites: a meta-analysis.

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.

SUBMITTER: Wang H

PROVIDER: S-EPMC6326306 | biostudies-literature | 2019 Jan

REPOSITORIES: biostudies-literature

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Diabetes mellitus and the risk of fractures at specific sites: a meta-analysis.

Wang Hao H Ba Ying Y Xing Qian Q Du Jian-Ling JL

BMJ open 20190103 1

<h4>Objective</h4>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.<h4>Design</h4>Meta-analysis DATA SOURCES: The PubMed, EMBASE and Cochrane Library databases were searched from inception to March 2018.<h4>Eligibility criteria</h4>We included prospective and retrospective cohort studies on the associations of DM and subsequent fractur ...[more]

PMID: 30610024

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Project description:PurposeIn this descriptive study, we examined the incidence of fractures in patients with newly treated type 2 diabetes mellitus (T2D) compared to matched reference population.MethodsParticipants from the UK Clinical Practice research datalink (CPRD) GOLD (1987-2017), aged ≥30 years, with a T2D diagnosis code and a first prescription for a non-insulin anti-diabetic drug (n = 124,328) were included. Cases with T2D were matched by year of birth, sex and practice to a reference population (n = 124,328), the mean follow-up was 7.7 years. Crude fracture incidence rates (IRs) and incidence rate ratios (IRRs) were calculated. Analyses were stratified by fracture site and sex and additionally adjusted for BMI, smoking status, alcohol use and history of any fracture at index date.ResultsThe IR of all fractures and major osteoporotic fractures was lower in T2D compared to the reference population (IRR 0.97; 95%CI 0.94-0.99). The IRs were lower for clavicle (IRR 0.67; 0.56-0.80), radius/ulna (IRR 0.81; 0.75-0.86) and vertebral fractures (0.83; 0.75-0.92) and higher for ankle (IRR 1.16; 95%CI 1.06-1.28), foot (1.11; 1.01-1.22), tibia/fibula (1.17; 1.03-1.32) and humerus fractures (1.11; 1.03-1.20). Differences in IRs at various fracture sites between T2D and the reference population were more pronounced in women than in men. In contrast, BMI adjusted IRs for all fractures (IRR 1.07; 1.04-1.10) and most individual fracture sites were significantly higher in T2D, especially in women.ConclusionThe crude incidence of all fractures was marginally lower in patients with newly treated T2D compared to the matched reference population but differed according to fracture site, especially in women. BMI adjusted analyses resulted in higher incidence rates in T2D at almost all fracture sites compared to crude incidence rates and this was more pronounced in women than in men. This implies that BMI may have a protective impact on the crude incidence of fractures, especially in women with newly treated T2D.

Dataset Information

Diabetes mellitus and the risk of fractures at specific sites: a meta-analysis.

Publications

Diabetes mellitus and the risk of fractures at specific sites: a meta-analysis.

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