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

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 complication...

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Veröffentlicht in:Bone (New York, N.Y.) Jg. 137; S. 115457
Hauptverfasser: Vilaca, Tatiane, Schini, Marian, Harnan, Susan, Sutton, Anthea, Poku, Edith, Allen, Isabel E., Cummings, Steven R., Eastell, Richard
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Elsevier Inc 01.08.2020
Schlagworte:
Accidental Falls
Adult
Bone Density
Diabetes
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 1 - epidemiology
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - epidemiology
Fracture risk
Hip fracture
Hip Fractures - epidemiology
Humans
Meta-analysis
Non-vertebral fracture
Osteoporotic Fractures
Spinal Fractures
Hip fracture
Diabetes
Fracture risk
Non-vertebral fracture
Meta-analysis
ISSN:8756-3282, 1873-2763, 1873-2763
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Abstract 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. 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. 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. Diabetes is associated with an increase in both hip and non-vertebral fracture risk. •The risk of hip fractures was greater in T1D than T2D.•Hip fracture risk is higher in people younger than 65 years for both type 1 and type 2 diabetes.•In type 2 diabetes, insulin use and longer diabetes duration is associated with greater risk of hip fractures.
AbstractList 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. 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. 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. Diabetes is associated with an increase in both hip and non-vertebral fracture risk. •The risk of hip fractures was greater in T1D than T2D.•Hip fracture risk is higher in people younger than 65 years for both type 1 and type 2 diabetes.•In type 2 diabetes, insulin use and longer diabetes duration is associated with greater risk of hip fractures.
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.BACKGROUNDDiabetes 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.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.METHODSWe 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.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.FINDINGSFrom 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.Diabetes is associated with an increase in both hip and non-vertebral fracture risk.CONCLUSIONDiabetes is associated with an increase in both hip and non-vertebral fracture risk.
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. 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. 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. Diabetes is associated with an increase in both hip and non-vertebral fracture risk.
ArticleNumber 115457
Author Schini, Marian
Cummings, Steven R.
Eastell, Richard
Sutton, Anthea
Allen, Isabel E.
Vilaca, Tatiane
Harnan, Susan
Poku, Edith
Author_xml – sequence: 1
  givenname: Tatiane
  orcidid: 0000-0002-9227-6076
  surname: Vilaca
  fullname: Vilaca, Tatiane
  email: tvilaca1@sheffield.ac.uk
  organization: Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK
– sequence: 2
  givenname: Marian
  orcidid: 0000-0003-2204-2095
  surname: Schini
  fullname: Schini, Marian
  email: m.schini@sheffield.ac.uk
  organization: Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK
– sequence: 3
  givenname: Susan
  surname: Harnan
  fullname: Harnan, Susan
  email: s.harnan@sheffield.ac.uk
  organization: School of Health and Related Research (ScHARR), University of Sheffield, UK
– sequence: 4
  givenname: Anthea
  surname: Sutton
  fullname: Sutton, Anthea
  email: a.sutton@sheffield.ac.uk
  organization: School of Health and Related Research (ScHARR), University of Sheffield, UK
– sequence: 5
  givenname: Edith
  surname: Poku
  fullname: Poku, Edith
  email: e.poku@sheffield.ac.uk
  organization: School of Health and Related Research (ScHARR), University of Sheffield, UK
– sequence: 6
  givenname: Isabel E.
  surname: Allen
  fullname: Allen, Isabel E.
  email: isabel.allen@ucsf.edu
  organization: University of California, San Francisco, USA
– sequence: 7
  givenname: Steven R.
  surname: Cummings
  fullname: Cummings, Steven R.
  email: SCummings@sfcc-cpmc.net
  organization: San Francisco Coordinating Center, Sutter Health, University of California, San Francisco, USA
– sequence: 8
  givenname: Richard
  orcidid: 0000-0002-0323-3366
  surname: Eastell
  fullname: Eastell, Richard
  email: r.eastell@sheffield.ac.uk
  organization: Academic Unit of Bone Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, UK
BackLink https://www.ncbi.nlm.nih.gov/pubmed/32480023$$D View this record in MEDLINE/PubMed
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10.1210/jc.2006-0460
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Keywords Hip fracture
Diabetes
Fracture risk
Non-vertebral fracture
Meta-analysis
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Snippet 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...
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SubjectTerms Accidental Falls
Adult
Bone Density
Diabetes
Diabetes Mellitus, Type 1 - complications
Diabetes Mellitus, Type 1 - epidemiology
Diabetes Mellitus, Type 2 - complications
Diabetes Mellitus, Type 2 - epidemiology
Fracture risk
Hip fracture
Hip Fractures - epidemiology
Humans
Meta-analysis
Non-vertebral fracture
Osteoporotic Fractures
Spinal Fractures
Title The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: A systematic review and meta-analysis update
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https://dx.doi.org/10.1016/j.bone.2020.115457
https://www.ncbi.nlm.nih.gov/pubmed/32480023
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