Diabetes mellitus is a risk factor for low bone mass-related fractures

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.