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

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% confidence
intervals (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: 1.17–1.48; P<0.001), hip (RR: 1.77; 95%
CI: 1.56–2.02; P<0.001), upper arm (RR: 1.47; 95% CI: 1.02–2.10;
P=0.037), and ankle fractures (RR: 1.24; 95% CI: 1.10–1.40;
P<0.001), whereas DM had no significant impact on the incidence of
distal forearm (RR: 1.02; 95% CI: 0.88–1.19; P=0.809) and vertebral
fractures (RR: 1.56; 95% CI: 0.78–3.12; P=0.209). RR ratios suggested that
compared with type 2 DM (T2DM) patients, type 1 DM (T1DM) patients had
greater risk of total (RR ratio: 1.24; 95% CI: 1.08–1.41; P=0.002), hip
(RR ratio: 3.43; 95% CI: 2.27–5.17; P<0.001), and ankle fractures
(RR ratio: 1.71; 95% CI: 1.06 –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: DM
patients had greater risks of total, hip, upper arm, and ankle fractures,
with T1DM having a more harmful effect than T2DM.