Type 1 diabetes and risk of fracture: meta-analysis and review of the literature

Aims: To conduct a systematic review and meta-analysis of observational studies in order to assess the association between Type 1 diabetes and fractures.

Background: The risk of fracture in men and women with Type 1 diabetes has not been studied in a large prospective well designed cohort.

Methods: Data were selected from Medline and Embase and abstracts from annual scientific meetings of various diabetes and bone and mineral societies. Published studies that reported the fracture risk in people with Type 1 diabetes in comparison with people without diabetes between 1990 and July 2014 and abstracts from various annual meeting (2005 onwards) were included in the present meta-analysis. Data were extracted from the text of included publications or from abstracts of conferences.

Results: The 14 studies that met the inclusion criteria reported 2066 fracture events among 27 300 people with Type 1 diabetes (7.6%) and 136 579 fracture events among 4 364 125 people without diabetes (3.1%). The pooled relative risk of any fracture in people with Type 1 diabetes was 3.16 (95% CI 1.51-6.63; P = 0.002). Women and men with Type 1 diabetes had a four and two times higher risk of any fractures, respectively, compared with people without diabetes. The pooled relative risks of hip fractures and spinal fractures were 3.78 (95% CI 2.05-6.98; P < 0.001) and 2.88 (95% CI 1.71-4.82; P < 0.001), respectively, among people with Type 1 diabetes.

Conclusions: Our meta-analysis suggests that both men and women with Type 1 diabetes might have an increased risk of any fractures. A large prospective epidemiological study is needed to confirm our findings.