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

Vilaça, Tatiane; Schini, Marian; Harnan, S; Sutton, Anthea; Poku, Edith; Allen, Isabel Elaine; Cummings, Steven R.; Eastell, Richard

doi:10.1016/j.bone.2020.115457

Cited by 156 publications

(101 citation statements)

References 101 publications

(163 reference statements)

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“…In addition, type 2 diabetes, which frequently coexists with obesity, may further impact fracture risk. Indeed, many studies reported increased risk of hip and non-vertebral fracture in individuals with type 2 diabetes [ 19 , 192 ]. However, studies considering presence of type 2 diabetes in the association between obesity and fracture risk are limited: most studies used type 2 diabetes as an adjustment factor and did not assess whether the presence of type 2 diabetes modifies the association between obesity and fracture incidence.…”

Section: Discussionmentioning

confidence: 99%

Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis

et al. 2021

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Background The association between obesity and fracture risk may be skeletal site- and sex-specific but results among studies are inconsistent. Whilst several studies reported higher bone mineral density (BMD) in patients with obesity, altered bone quality could be a major determinant of bone fragility in this population. Objectives This systematic review and meta-analysis aimed to compare, in men, premenopausal women and postmenopausal women with obesity vs. individuals without obesity: 1) the incidence of fractures overall and by site; 2) BMD; and 3) bone quality parameters (circulating bone turnover markers and bone microarchitecture and strength by advanced imaging techniques). Data sources PubMed (MEDLINE), EMBASE, Cochrane Library and Web of Science were searched from inception of databases until the 13th of January 2021. Data synthesis Each outcome was stratified by sex and menopausal status in women. The meta-analysis was performed using a random-effect model with inverse-variance method. The risks of hip and wrist fracture were reduced by 25% (n = 8: RR = 0.75, 95% CI: 0.62, 0.91, P = 0.003, I2 = 95%) and 15% (n = 2 studies: RR = 0.85, 95% CI: 0.81, 0.88), respectively, while ankle fracture risk was increased by 60% (n = 2 studies: RR = 1.60, 95% CI: 1.52, 1.68) in postmenopausal women with obesity compared with those without obesity. In men with obesity, hip fracture risk was decreased by 41% (n = 5 studies: RR = 0.59, 95% CI: 0.44, 0.79). Obesity was associated with increased BMD, better bone microarchitecture and strength, and generally lower or unchanged circulating bone resorption, formation and osteocyte markers. However, heterogeneity among studies was high for most outcomes, and overall quality of evidence was very low to low for all outcomes. Conclusions This meta-analysis highlights areas for future research including the need for site-specific fracture studies, especially in men and premenopausal women, and studies comparing bone microarchitecture between individuals with and without obesity. Systematic review registration number CRD42020159189

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Section: Discussionmentioning

confidence: 99%

Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis

et al. 2021

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“…In der 2. Metaanalyse [ 40 ] wurden 49 Studien mit insgesamt mehr als 17 Mio. Teilnehmern und 319.652 Hüftfrakturen und knapp 3 Mio.…”

Section: Endokrinologieunclassified

Diabetes Update 2021

Scherbaum

2021

Diabetologe

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“…The meta-analyses that evaluated the fracture risk in T2DM patients are summarized in Table 1 . Among the skeletal sites, increased risk of hip fracture (8%-70%) has been reported consistently in most of the meta-analyses[ 14 , 39 - 42 ]. Young age, prolonged duration of diabetes, use of insulin[ 39 ] and Asian ethnicity[ 40 ] are the factors that have been associated with a higher risk of hip fracture in diabetic patients.…”

Section: Bone Health In T2dmmentioning

confidence: 99%

Critical review of bone health, fracture risk and management of bone fragility in diabetes mellitus

Palui

Pramanik

Mondal

et al. 2021

WJD

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The risk of fracture is increased in both type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). However, in contrast to the former, patients with T2DM usually possess higher bone mineral density. Thus, there is a considerable difference in the pathophysiological basis of poor bone health between the two types of diabetes. Impaired bone strength due to poor bone microarchitecture and low bone turnover along with increased risk of fall are among the major factors behind elevated fracture risk. Moreover, some antidiabetic medications further enhance the fragility of the bone. On the other hand, antiosteoporosis medications can affect the glucose homeostasis in these patients. It is also difficult to predict the fracture risk in these patients because conventional tools such as bone mineral density and Fracture Risk Assessment Tool score assessment can underestimate the risk. Evidence-based recommendations for risk evaluation and management of poor bone health in diabetes are sparse in the literature. With the advancement in imaging technology, newer modalities are available to evaluate the bone quality and risk assessment in patients with diabetes. The purpose of this review is to explore the pathophysiology behind poor bone health in diabetic patients. Approach to the fracture risk evaluation in both T1DM and T2DM as well as the pragmatic use and efficacy of the available treatment options have been discussed in depth.

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

Cited by 156 publications

References 101 publications

Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis

Association between obesity and risk of fracture, bone mineral density and bone quality in adults: A systematic review and meta-analysis

Diabetes Update 2021

Critical review of bone health, fracture risk and management of bone fragility in diabetes mellitus

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