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

Table 1 Summary of meta-analyses evaluating risk of fracture in patients with type 2 diabetes mellitus

Ref.	Fracture site	Risk effect (95%CI)	P value	Risk factors (site)
Vilaca et al[39], 2020	Hip	RR 1.33 (1.19-1.49)	S	Younger age, female gender, insulin use, longer duration of diabetes (hip)
	Nonvertebral	RR 1.19 (1.11-1.28)	S
Koromani et al[43], 2020	Vertebral (incident)	OR 1.35(1.27-1.44)	S
	Vertebral (prevalent)	OR 0.84 (0.74-0.95)	S
Wang et al[36], 2019	All	RR 1.22 (1.13-1.31)	S
	Hip	RR 1.27 (1.16-1.39)	S
	Distal forearm	RR 0.97 (0.66-1.09)	NS
	Upper arm	RR 1.54 (1.19-1.99)	S
	Ankle	RR 1.15 (1.01-1.31)	S
	Vertebrae	RR 1.74 (0.96-3.16)	NS
Liu et al[44], 2018	Limb	RR 1.18 (1.02-1.35)	S	Female gender (leg/ankle)
	Leg/Ankle	RR 1.80 (1.13-2.87)	S
	Humerus	RR 1.27 (0.60-2.68)	NS
	Wrist/hand/foot	RR 1.26 (0.94-1.71)	NS
	Forearm	RR 0.98 (0.78-1.23)	NS
Vilaca et al[45], 20191	Ankle	RR 1.30 (1.15-1.48)	S
	Wrist	RR 0.85 (0.77-0.95)	S
Moayeri et al[37], 2017	All	RR 1.05 (1.04-1.06)	S	Older age, male gender, duration of diabetes. Insulin use, Corticosteroid use (overall)
	Hip	RR 1.20 (1.17-1.23)	S
	Vertebral	RR 1.16 (1.05-1.28)	S
	Foot	RR 1.37 (1.21-1.54)	S
	Wrist	RR 0.98 (0.88-1.07)	NS
	Proximal humerus	RR 1.09 (0.86-1.31)	NS
	Ankle	RR 1.13 (0.95-1.32)	NS
Jia et al[38], 20172	All	IRR 1.23 (1.12-1.35)	S
	Hip	IRR 1.08 (1.02-1.15)	S
	Vertebrae	IRR 1.21 (0.98-1.48)	NS
Ni and Fan[42], 2017	All LBMF	RR 1.24 (1.09-1.41)	S	Female gender
Dytfeld and Michalak[40], 20173	Hip	OR 1.30 (1.07-1.57)	S	Cohort studies, Studies conducted in Asia (hip)
	Vertebral	OR 1.13 (0.94-1.37)	NS
Fan et al[41], 2016	Hip	RR 1.34 (1.19-1.51)	S
Vestergaard[16], 2007	Hip	RR 1.38 (1.25-1.53)	S
	Wrist	RR 1.19 (1.01-1.41)	S
	Vertebrae	RR 0.93 (0.63-1.37)	NS
	All	RR 0.96 (0.57-1.61)	NS
Janghorbani et al[14], 2007	Hip	RR 1.7 (1.3-2.2)	S

¹Study included both type 1 and type 2 diabetes.

²Low energy fractures.

³Low energy fractures in postmenopausal women. CI: Confidence interval; IRR: Incidence rate ratio; LBMF: Low bone mass-related fractures; NS: Not significant; OR: Odds ratio; RR: Relative risk; S: Statistically significant.