Diabetes mellitus and risk of hip fractures: a meta-analysis

Osteoporos Int. 2016 Jan;27(1):219-28. doi: 10.1007/s00198-015-3279-7. Epub 2015 Aug 12.


This meta-analysis revealed that diabetic adults had a twofold greater risk of hip fractures compared with non-diabetic populations, and this association was more pronounced in type 1 diabetes.

Introduction: The relationship between diabetes mellitus and risk of hip fracture yielded conflicting results. We conducted a meta-analysis to investigate the association between diabetes mellitus and the risk of hip fractures based on observational studies.

Methods: We conducted a systematic literature search of PubMed and Embase databases through May 2015. We selected cohort and case-control studies providing at least age-adjusted risk ratio (RR) and corresponding 95 % confidence intervals (CI) of hip fractures among diabetic and non-diabetic subjects. Moreover, we pooled the female-to-male RR of hip fractures from studies that reported gender-specific risk estimate in a single study.

Results: Twenty-one studies involving 82,293 hip fracture events among 6,995,272 participants were identified. Diabetes mellitus was associated with an increased risk of hip fractures (RR 2.07; 95 % CI 1.83-2.33) in a random effects model. Subgroup analysis indicated that excess risk of hip fracture was more pronounced in type 1 diabetes (RR 5.76; 95 % CI 3.66-9.07) than that in type 2 diabetes (RR 1.34; 95 % CI 1.19-1.51). The pooled female-to-male RR of hip fractures was 1.09 (95 % CI 0.93-1.28).

Conclusions: Individuals with diabetes mellitus have an excessive risk of hip fractures, and this relationship is more pronounced in type 1 diabetes. The association between diabetes and hip fracture risk is similar in men and women.

Keywords: Diabetes mellitus; Gender difference; Hip fracture; Meta-analysis; Risk factors.

Publication types

  • Meta-Analysis

MeSH terms

  • Diabetes Mellitus, Type 1 / complications*
  • Diabetes Mellitus, Type 1 / epidemiology
  • Diabetes Mellitus, Type 2 / complications*
  • Diabetes Mellitus, Type 2 / epidemiology
  • Female
  • Hip Fractures / epidemiology
  • Hip Fractures / etiology*
  • Humans
  • Male
  • Observational Studies as Topic
  • Osteoporotic Fractures / epidemiology
  • Osteoporotic Fractures / etiology*
  • Risk Assessment / methods
  • Risk Factors
  • Sex Factors