Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Osteoporosis International
Published in: Osteoporosis International 1/2016

01-01-2016 | Original Article

Diabetes mellitus and risk of hip fractures: a meta-analysis

Authors: Y. Fan, F. Wei, Y. Lang, Y. Liu

Published in: Osteoporosis International | Issue 1/2016

Login to get access

Abstract

Summary

This meta-analysis revealed that diabetic adults had a twofold greater risk of hip fractures compared with non-diabetic populations, and this association was more pronounced in type 1 diabetes.

Introduction

The relationship between diabetes mellitus and risk of hip fracture yielded conflicting results. We conducted a meta-analysis to investigate the association between diabetes mellitus and the risk of hip fractures based on observational studies.

Methods

We conducted a systematic literature search of PubMed and Embase databases through May 2015. We selected cohort and case–control studies providing at least age-adjusted risk ratio (RR) and corresponding 95 % confidence intervals (CI) of hip fractures among diabetic and non-diabetic subjects. Moreover, we pooled the female-to-male RR of hip fractures from studies that reported gender-specific risk estimate in a single study.

Results

Twenty-one studies involving 82,293 hip fracture events among 6,995,272 participants were identified. Diabetes mellitus was associated with an increased risk of hip fractures (RR 2.07; 95 % CI 1.83–2.33) in a random effects model. Subgroup analysis indicated that excess risk of hip fracture was more pronounced in type 1 diabetes (RR 5.76; 95 % CI 3.66–9.07) than that in type 2 diabetes (RR 1.34; 95 % CI 1.19–1.51). The pooled female-to-male RR of hip fractures was 1.09 (95 % CI 0.93–1.28).

Conclusions

Individuals with diabetes mellitus have an excessive risk of hip fractures, and this relationship is more pronounced in type 1 diabetes. The association between diabetes and hip fracture risk is similar in men and women.
Appendix
Available only for authorised users
Literature
1.
Kanis JA, Oden A, McCloskey EV, Johansson H, Wahl DA, Cooper C (2012) A systematic review of hip fracture incidence and probability of fracture worldwide. Osteoporos Int 23:2239–56PubMedPubMedCentralCrossRef
2.
Cooper C, Cole ZA, Holroyd CR, Earl SC, Harvey NC, Dennison EM et al (2011) Secular trends in the incidence of hip and other osteoporotic fractures. Osteoporos Int 22:1277–88PubMedPubMedCentralCrossRef
3.
Gulcelik NE, Bayraktar M, Caglar O, Alpaslan M, Karakaya J (2011) Mortality after hip fracture in diabetic patients. Exp Clin Endocrinol Diabetes 119:414–8PubMedCrossRef
4.
Kannegaard PN, van der Mark S, Eiken P, Abrahamsen B (2010) Excess mortality in men compared with women following a hip fracture. National analysis of comedications, comorbidity and survival. Age Ageing 39:203–9PubMedCrossRef
5.
Bertram M, Norman R, Kemp L, Vos T (2011) Review of the long-term disability associated with hip fractures. Inj Prev 17:365–70PubMedCrossRef
6.
Reistetter TA, Graham JE, Deutsch A, Markello SJ, Granger CV, Ottenbacher KJ (2011) Diabetes comorbidity and age influence rehabilitation outcomes after hip fracture. Diabetes Care 34:1375–7PubMedPubMedCentralCrossRef
7.
8.
Whiting DR, Guariguata L, Weil C, Shaw J (2011) IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract 94:311–21PubMedCrossRef
9.
10.
Nicodemus KK, Folsom AR (2001) Type 1 and type 2 diabetes and incident hip fractures in postmenopausal women. Diabetes Care 24:1192–7PubMedCrossRef
11.
Janghorbani M, Feskanich D, Willett WC, Hu F (2006) Prospective study of diabetes and risk of hip fracture: the Nurses’ Health Study. Diabetes Care 29:1573–8PubMedCrossRef
12.
Holmberg AH, Johnell O, Nilsson PM, Nilsson J, Berglund G, Akesson K (2006) Risk factors for fragility fracture in middle age. A prospective population-based study of 33,000 men and women. Osteoporos Int 17:1065–77PubMedCrossRef
13.
Dobnig H, Piswanger-Solkner JC, Roth M, Obermayer-Pietsch B, Tiran A, Strele A et al (2006) Type 2 diabetes mellitus in nursing home patients: effects on bone turnover, bone mass, and fracture risk. J Clin Endocrinol Metab 91:3355–63PubMedCrossRef
14.
Forsen L, Meyer HE, Midthjell K, Edna TH (1999) Diabetes mellitus and the incidence of hip fracture: results from the Nord-Trondelag Health Survey. Diabetologia 42:920–5PubMedCrossRef
15.
Ahmed LA, Joakimsen RM, Berntsen GK, Fonnebo V, Schirmer H (2006) Diabetes mellitus and the risk of non-vertebral fractures: the Tromso study. Osteoporos Int 17:495–500PubMedCrossRef
16.
Schwartz AV, Sellmeyer DE, Ensrud KE, Cauley JA, Tabor HK, Schreiner PJ et al (2001) Older women with diabetes have an increased risk of fracture: a prospective study. J Clin Endocrinol Metab 86:32–8PubMedCrossRef
17.
Meyer HE, Tverdal A, Falch JA (1993) Risk factors for hip fracture in middle-aged Norwegian women and men. Am J Epidemiol 137:1203–11PubMed
18.
Vestergaard P, Rejnmark L, Mosekilde L (2005) Relative fracture risk in patients with diabetes mellitus, and the impact of insulin and oral antidiabetic medication on relative fracture risk. Diabetologia 48:1292–9PubMedCrossRef
19.
Miao J, Brismar K, Nyren O, Ugarph-Morawski A, Ye W (2005) Elevated hip fracture risk in type 1 diabetic patients: a population-based cohort study in Sweden. Diabetes Care 28:2850–5PubMedCrossRef
20.
Ivers RQ, Cumming RG, Mitchell P, Peduto AJ (2001) Diabetes and risk of fracture: The Blue Mountains Eye Study. Diabetes Care 24:1198–203PubMedCrossRef
21.
Ottenbacher KJ, Ostir GV, Peek MK, Goodwin JS, Markides KS (2002) Diabetes mellitus as a risk factor for hip fracture in mexican american older adults. J Gerontol A Biol Sci Med Sci 57:M648–53PubMedCrossRef
22.
de L, II, van der Klift M, de Laet CE, van Daele PL, Hofman A, Pols HA. Bone mineral density and fracture risk in type-2 diabetes mellitus: the Rotterdam Study. Osteoporos Int. 2005;16:1713–20.
23.
Janghorbani M, Van Dam RM, Willett WC, Hu FB (2007) Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol 166:495–505PubMedCrossRef
24.
Leslie WD, Lix LM, Prior HJ, Derksen S, Metge C, O’Neil J (2007) Biphasic fracture risk in diabetes: a population-based study. Bone 40:1595–601PubMedCrossRef
25.
Lipscombe LL, Jamal SA, Booth GL, Hawker GA (2007) The risk of hip fractures in older individuals with diabetes: a population-based study. Diabetes Care 30:835–41PubMedCrossRef
26.
Chen HF, Ho CA, Li CY (2008) Increased risks of hip fracture in diabetic patients of Taiwan: a population-based study. Diabetes Care 31:75–80PubMedCrossRef
27.
Koh WP, Wang R, Ang LW, Heng D, Yuan JM, Yu MC (2010) Diabetes and risk of hip fracture in the Singapore Chinese Health Study. Diabetes Care 33:1766–70PubMedPubMedCentralCrossRef
28.
Strotmeyer ES, Kamineni A, Cauley JA, Robbins JA, Fried LF, Siscovick DS et al (2011) Potential explanatory factors for higher incident hip fracture risk in older diabetic adults. Curr Gerontol Geriatr Res 2011:979270PubMedPubMedCentralCrossRef
29.
Giangregorio LM, Leslie WD, Lix LM, Johansson H, Oden A, McCloskey E et al (2012) FRAX underestimates fracture risk in patients with diabetes. J Bone Miner Res 27:301–8PubMedCrossRef
30.
Oei L, Zillikens MC, Dehghan A, Buitendijk GH, Castano-Betancourt MC, Estrada K et al (2013) High bone mineral density and fracture risk in type 2 diabetes as skeletal complications of inadequate glucose control: the Rotterdam Study. Diabetes Care 36:1619–28PubMedPubMedCentralCrossRef
31.
Hothersall EJ, Livingstone SJ, Looker HC, Ahmed SF, Cleland S, Leese GP et al (2014) Contemporary risk of hip fracture in type 1 and type 2 diabetes: a national registry study from Scotland. J Bone Miner Res 29:1054–60PubMedPubMedCentralCrossRef
32.
Martinez-Laguna D, Tebe C, Javaid MK, Nogues X, Arden NK, Cooper C et al (2015) Incident type 2 diabetes and hip fracture risk: a population-based matched cohort study. Osteoporos Int 26:827–33PubMedCrossRef
33.
Stroup DF, Berlin JA, Morton SC, Olkin I, Williamson GD, Rennie D et al (2000) Meta-analysis of observational studies in epidemiology: a proposal for reporting. Meta-analysis Of Observational Studies in Epidemiology (MOOSE) group. JAMA 283:2008–12PubMedCrossRef
34.
Moher D, Liberati A, Tetzlaff J, Altman DG (2009) Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 151:264–9, W64 PubMedCrossRef
35.
36.
Higgins JPT, Green S, Editors. Cochrane handbook for systematic reviews of interventions version 5.1.0 [updated March 2011]: the Cochrane collaboration; 2011.
37.
38.
Begg CB, Mazumdar M (1994) Operating characteristics of a rank correlation test for publication bias. Biometrics 50:1088–101PubMedCrossRef
39.
40.
de Ferranti SD, de Boer IH, Fonseca V, Fox CS, Golden SH, Lavie CJ et al (2014) Type 1 diabetes mellitus and cardiovascular disease: a scientific statement from the American Heart Association and American Diabetes Association. Circulation 130:1110–30PubMedCrossRef
41.
Engelgau MM, Geiss LS, Saaddine JB, Boyle JP, Benjamin SM, Gregg EW et al (2004) The evolving diabetes burden in the United States. Ann Intern Med 140:945–50PubMedCrossRef
42.
Tang X, Liu G, Kang J, Hou Y, Jiang F, Yuan W et al (2013) Obesity and risk of hip fracture in adults: a meta-analysis of prospective cohort studies. PLoS One 8:e55077PubMedPubMedCentralCrossRef
43.
Khalil N, Sutton-Tyrrell K, Strotmeyer ES, Greendale GA, Vuga M, Selzer F et al (2011) Menopausal bone changes and incident fractures in diabetic women: a cohort study. Osteoporos Int 22:1367–76PubMedPubMedCentralCrossRef
44.
Vestergaard P (2009) Bone metabolism in type 2 diabetes and role of thiazolidinediones. Curr Opin Endocrinol Diabetes Obes 16:125–31PubMedCrossRef
45.
Carnevale V, Romagnoli E, D’Erasmo L, D’Erasmo E (2014) Bone damage in type 2 diabetes mellitus. Nutr Metab Cardiovasc Dis 24:1151–7PubMedCrossRef
46.
de Waard EA, van Geel TA, Savelberg HH, Koster A, Geusens PP, van den Bergh JP (2014) Increased fracture risk in patients with type 2 diabetes mellitus: an overview of the underlying mechanisms and the usefulness of imaging modalities and fracture risk assessment tools. Maturitas 79:265–74PubMedCrossRef
Metadata
Title
Diabetes mellitus and risk of hip fractures: a meta-analysis
Authors
Y. Fan
F. Wei
Y. Lang
Y. Liu
Publication date
01-01-2016
Publisher
Springer London
Published in
Osteoporosis International / Issue 1/2016
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-015-3279-7

Other articles of this Issue 1/2016

Osteoporosis International 1/2016 Go to the issue

Original Article

Proton-pump inhibitors and risk of fractures: an update meta-analysis

Original Article

A phase 2 study of MK-5442, a calcium-sensing receptor antagonist, in postmenopausal women with osteoporosis after long-term use of oral bisphosphonates

Letter

Bone remodeling markers: so easy to measure, so difficult to interpret

Original Article

Serotonergic antidepressant use and the risk of fracture: a population-based nested case–control study

Review

Does salmon calcitonin cause cancer? A review and meta-analysis

Original Article

Association between prolonged breastfeeding and bone mineral density and osteoporosis in postmenopausal women: KNHANES 2010-2011