Clinical Summary

Hip and Non-vertebral Fractures Risk in Type 1 and Type 2 Diabetes

Sarfaroj Khan

Takeaway

Diabetes is associated with an increased risk of hip and non-vertebral fractures; hip fractures risk is higher in type 1 diabetes (T1D) than type 2 diabetes (T2D).
In both T1D and T2D, the risk of hip fractures is higher in the younger population (age, <65 years).
Insulin use and longer diabetes duration increase the risk of hip fractures in T2D.

Why this matters

This is the first meta-analysis to assess the effect of age, insulin use, and diabetes duration on the risk of fractures in diabetes.

Study design

Meta-analysis of 49 studies.
Hip fractures analysis (42 studies, n=17,571,738 participants with 319,652 fractures).
Non-vertebral fractures analysis (17 studies, n=2,978,487 participants with 181,228 non-vertebral fractures).
Funding: Amgen Inc.

Key results

Diabetes was associated with an increased risk of hip and non-vertebral fractures:
- T1D:
  - hip fractures (relative risk [RR], 4.93; 95% CI, 3.06-7.95; I², 94.9%); and
  - non-vertebral fractures (RR, 1.92; 95% CI, 0.92-3.99; I², 78.1%).
- T2D:
  - hip fractures (RR, 1.37; 95% CI, 1.22-2.21; I², 87.8%); and
  - non-vertebral fractures (RR, 1.19; 95% CI, 1.11-1.28; I², 25.2%).
The risk of hip fractures was higher in the younger population (<65 years of age, 3.21; 95% CI, 2.38-4.32; I², 94.9%) compared to the elderly (>65 years of age, RR, 1.21; 95% CI, 1.14-1.28) in both T1D and T2D.
In patients with T2D, the risk of hip fracture was higher in:
- females (RR, 1.34; 95% CI, 1.17-1.54);
- those with longer diabetes duration (>5 years: RR, 1.59; 95% CI, 1.33-1.90 and >10 years: RR, 2.40; 95% CI, 1.89-3.04); and
- insulin users (RR, 1.79; 95% CI, 1.19-2.69; I², 82.7%).

Limitations

Heterogeneity among included studies.

Vilaca T, Schini M, Harnan S, Sutton A, Poku E, Allen IE, Cummings SR, Eastell R. The risk of hip and non-vertebral fractures in type 1 and type 2 diabetes: A systematic review and meta-analysis update. Bone. 2020 May 29 [Epub ahead of print]:115457. doi: 10.1016/j.bone.2020.115457. PMID: 32480023. View abstract.

This clinical summary first appeared on Univadis, part of the Medscape Professional Network.