title: Type 2 diabetes and risk of low-energy fractures in postmenopausal women: meta-analysis of observational studies.
abstract: BACKGROUND
  Observational studies on osteoporotic fractures in patients with type 2 diabetes indicate their increased incidence compared to those without diabetes, but results are inconsistent. Currently, type 2 diabetes is not considered as an independent risk factor for low-energy fractures in elder subjects. The aim of the study was to assess the association between type 2 diabetes and risk for hip and vertebral fractures in postmenopausal women.
  
  
  METHODS
  We searched Medline, Web of Science and Cochrane databases for articles published before September 2013. Studies assessing fractures in women aged >50 diagnosed with type 2 diabetes, regardless of the diabetes treatment, were deemed eligible. To estimate fracture risk meta-analysis in a random effect model was performed. The results were shown by the odds ratio (OR) and 95 % confidence interval (CI). Heterogeneity was tested using a Q-Cochrane test (significance was analyzed with p < 0.10) and I2measure.
  
  
  RESULTS
  A total of 15 observational studies (11 cohort and 4 cross-sectional, 263.006 diabetics and 502.115 controls) were included. Thirteen papers provided information on the incidence of hip fractures, and seven on vertebral ones. The meta-analysis revealed type 2 diabetes was associated with higher risk for hip fracture (OR 1.296, 95 % CI (1.069-1.571), but not vertebral fracture (OR = 1.134, 95 % CI (0.936-1.374). There was significant heterogeneity between hip fracture studies. American origin was identified as a potential source of such heterogeneity.
  
  
  CONCLUSIONS
  The results of our meta-analysis indicate there is an increased risk for hip fracture in postmenopausal women with type 2 diabetes.
authors.affiliation: Department of Family Medicine, Poznan University of Medical Sciences, ul. Przybyszewskiego 49, 60-355, Poznań, Poland. dytfeld@poczta.onet.pl.
authors.forename: Joanna
authors.initials: J
authors.lastname: Dytfeld
authors.affiliation: Department of Computer Science and Statistics, Poznan University of Medical Sciences, ul. Dąbrowskiego 79, 60-529, Poznań, Poland.
authors.forename: Michał
authors.initials: M
authors.lastname: Michalak
mesh_terms: D000368:Aged; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D006620:Hip Fractures / Q000175:diagnosis / Q000453:epidemiology; D006801:Humans; D064887:Observational Studies as Topic; D015663:Osteoporosis, Postmenopausal / Q000150:complications / Q000453:epidemiology; D058866:Osteoporotic Fractures / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors
keywords: Fracture; Osteoporosis; Type 2 diabetes