Diabetes mellitus is a risk factor for low bone mass-related fractures: A meta-analysis of cohort studies

BACKGROUND: Diabetes mellitus (DM) is inconsistently associated with the risk of low bone mass-related fractures (LBMF). This study aimed to summarize available cohort studies regarding the strength of association between type 2 diabetes mellitus (T2DM) and LBMF. METHODS: Electronic searches of PubMed, Embase, and the Cochrane Library were performed to identify studies through April 2016. Cohort studies that reported effect estimates with 95% confidence intervals (CIs) of LBMF for T2DM and control comparison were included. RESULTS: The summary relative risks (RRs) for T2DM versus non-T2DM were associated with a higher risk of LBMF (RR: 1.24; 95% CI: 1.09–1.41; P = .001). Further, women with T2DM showed a harmful impact on the incidence of LBMF (RR: 1.19; 95% CI: 1.04–1.36; P = .010). However, in men, T2DM showed no significant impact on the risk of LBMF (RR: 1.14; 95% CI: 0.93–1.39; P = .215). Furthermore, the summary results suggested an association between T2DM and LBMF in studies that reported hazard ratio (HR) as an effect estimate in total cohorts (HR: 1.31; 95% CI: 1.17–1.46; P < .001), men (HR: 1.26; 95% CI: 1.11–1.43; P < .001), and women (HR: 1.32; 95% CI: 1.16–1.50; P < .001). However, these significant associations were not observed in studies that reported RR/odds ratio as an effect estimate. CONCLUSIONS: The present meta-analysis confirmed that T2DM was associated with an increased prevalence of LBMF compared with non-T2DM.