Vilaca, T. orcid.org/0000-0002-9227-6076, Walsh, J. orcid.org/0000-0002-7122-2650 and Eastell, R. orcid.org/0000-0002-0323-3366 (2019) Discordant pattern of peripheral fractures in diabetes: a meta-analysis on the risk of wrist and ankle fractures. Osteoporosis International, 30 (1). pp. 135-143. ISSN 0937-941X
Abstract
Summary
To clarify if the peripheral microarchitectural abnormalities described in diabetics have clinical consequences, we evaluated the risk of wrist and ankle fractures. The meta-analysis resulted in an increase in the risk of ankle fractures and a decrease in wrist fractures risk, suggesting that microarchitecture may not be the major fracture determinant.
Introduction
There is evidence for an increase in the risk of hip fractures in diabetes (both in type 1 and 2), but the risk is not established for other skeletal sites. Microarchitecture evaluations have reported a decrease in volumetric bone mineral density and an increase in cortical porosity at the radius and tibia. To investigate if there is a clinical consequence for these microarchitectural abnormalities, we performed a systematic review and meta-analysis on the risk of ankle and wrist fractures in diabetes.
Methods
Medline and Embase were searched using the terms ‘diabetes mellitus’, ‘fracture’, ‘ankle’, ‘radius’ and ‘wrist’. Relative risks and 95% confidence intervals were calculated using random effects model.
Results
For ankle fractures, six studies were selected including 2,137,223 participants and 15,395 fractures. For wrist fractures, 10 studies were eligible with 2,773,222 subjects and 39,738 fractures. The studies included men and women, ages 20 to 109 years for the wrist and 27 to 109 years for the ankle. The vast majority of subjects had type 2 diabetes.
Diabetes was associated with an increase in the risk of ankle fractures (RR 1.30 95%CI 1.15–1.48) and a decrease in wrist fractures (RR 0.85 95%CI 0.77-0.95). In the studies that reported body mass index (BMI), the mean values were 10% higher in the diabetic groups than controls.
Conclusion
The risk of fractures is increased in diabetes at the ankle and decreased at the wrist. The same pattern is observed in obesity. Although bone microarchitectural features are different in obesity and diabetes, the epidemiology of peripheral fractures is similar in both diseases suggesting that microarchitecture may not be the major determinant of peripheral fractures in these populations.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2018 International Osteoporosis Foundation and National Osteoporosis Foundation. |
Keywords: | Ankle fractures; Bone; Diabetes; Wrist fractures; Ankle Fractures; Diabetes Complications; Diabetes Mellitus; Humans; Osteoporotic Fractures; Risk Assessment; Wrist Injuries |
Dates: |
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Institution: | The University of Sheffield |
Academic Units: | The University of Sheffield > Faculty of Medicine, Dentistry and Health (Sheffield) > The Medical School (Sheffield) > Division of Genomic Medicine (Sheffield) > Department of Oncology and Metabolism (Sheffield) |
Funding Information: | Funder Grant number Medical Research Council MR/K006312/1 MEDICAL RESEARCH COUNCIL MR/P020941/1 |
Depositing User: | Symplectic Sheffield |
Date Deposited: | 18 Jan 2023 15:09 |
Last Modified: | 18 Jan 2023 15:09 |
Status: | Published |
Publisher: | Springer Science and Business Media LLC |
Refereed: | Yes |
Identification Number: | 10.1007/s00198-018-4717-0 |
Related URLs: | |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:195255 |