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Fracture risk in young and middle‐aged adults with type 1 diabetes mellitus: A systematic review and meta‐analysis
Author(s) -
Thong Eleanor P.,
Herath Madhuni,
Weber David R.,
Ranasinha Sanjeeva,
Ebeling Peter R.,
Milat Frances,
Teede Helena
Publication year - 2018
Publication title -
clinical endocrinology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.055
H-Index - 147
eISSN - 1365-2265
pISSN - 0300-0664
DOI - 10.1111/cen.13761
Subject(s) - medicine , meta analysis , type 1 diabetes , hip fracture , diabetes mellitus , relative risk , pediatrics , osteoporosis , endocrinology , confidence interval
Summary Background Type 1 diabetes mellitus (T1 DM ) is associated with skeletal fragility. While previous meta‐analyses have demonstrated an increased risk of fracture in individuals with T1 DM , little is known about fracture risk in T1 DM , in the absence of age‐related confounders. Aims To determine the risk of fracture in young and middle‐aged adults with T1 DM aged 18‐50 years old. Design Systematic review and meta‐analysis. Data sources Ovid MEDLINE , PubMed, EMBASE , EBM reviews and relevant conference abstracts. Study inclusion criteria Studies of adults aged between 18‐50 years with type 1 diabetes mellitus, with reported fracture outcomes. Primary outcomes Incident or prevalent fracture. Results Six studies were included in the meta‐analysis. A total of 1724 fractures occurred in 35 925 patients with T1 DM and 48 253 fractures occurred in 2 455 016 controls. RR for all fractures was 1.88 (95% CI 1.52‐2.32, P < .001). Fifty‐six hip fractures occurred among 34 707 patients with T1 DM and 594 hip fractures occurred in 2 295 177 controls. The RR of hip fractures was 4.40 (95% CI 2.58‐7.50, P < .001). Females and males with T1 DM had a RR of 5.79 (95% CI 3.55‐9.44, P < .001) and 3.67 (95% CI 2.10‐6.41, P < .001), respectively. Conclusions In the absence of age‐related comorbidities, fracture risk remains significantly elevated in young and middle‐aged adults with T1 DM . Younger age does not mitigate against hip fracture risk in T1 DM , and health professionals need to be aware of this risk. Further studies are needed to evaluate the mechanisms of fracture in T1 DM .