Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: a systematic review and meta-analysis
Received 8 January 2017
Accepted for publication 23 February 2017
Published 11 April 2017 Volume 2017:13 Pages 455—468
Checked for plagiarism Yes
Review by Single-blind
Peer reviewer comments 2
Editor who approved publication: Professor Garry Walsh
Ardeshir Moayeri,1 Mahmoud Mohamadpour,2 Seyedeh Fatemeh Mousavi,3 Ehsan Shirzadpour,2 Safoura Mohamadpour,3 Mansour Amraei4
1Department of Anatomy, 2Department of Biochemistry, Faculty of Medicine, 3Department of Epidemiology, Prevention of Psychosocial Injuries Research Center, 4Department of Physiology, Faculty of Medicine, Ilam University of Medical Sciences, Ilam, Iran
Aim: Patients with type 2 diabetes mellitus (T2DM) have an increased risk of bone fractures. A variable increase in fracture risk has been reported depending on skeletal site, diabetes duration, study design, insulin use, and so on. The present meta-analysis aimed to investigate the association between T2DM with fracture risk and possible risk factors.
Methods: Different databases including PubMed, Institute for Scientific Information, and Scopus were searched up to May 2016. All epidemiologic studies on the association between T2DM and fracture risk were included. The relevant data obtained from these papers were analyzed by a random effects model and publication bias was assessed by funnel plot. All analyses were done by R software (version 3.2.1) and STATA (version 11.1).
Results: Thirty eligible studies were selected for the meta-analysis. We found a statistically significant positive association between T2DM and hip, vertebral, or foot fractures and no association between T2DM and wrist, proximal humerus, or ankle fractures. Overall, T2DM was associated with an increased risk of any fracture (summary relative risk =1.05, 95% confidence interval: 1.04, 1.06) and increased with age, duration of diabetes, and insulin therapy.
Conclusion: Our findings strongly support an association between T2DM and increased risk of overall fracture. These findings emphasize the need for fracture prevention strategies in patients with diabetes.
Keywords: diabetes mellitus, fractures, bone, osteoporosis, risk factors, meta-analysis
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