title: Lifestyle-Related Metabolic Disorders, Osteoporosis, and Fracture Risk in Asia: A Systematic Review.
abstract: BACKGROUND
  The prevalence of both lifestyle-related metabolic disorders and osteoporosis is increasing in Asia.
  
  
  OBJECTIVE
  To conduct a systematic review of the published literature to identify studies examining disorders of glucose and lipid metabolism (type 2 diabetes, hyperglycemia, hypercholesterolemia, hyperlipidemia, dyslipidemia, metabolic syndrome [MetS], and atherosclerosis) as risk factors for osteoporosis and fracture in Asian populations. Studies examining the relationship between metabolic disorders and bone mineral density (BMD) were also included.
  
  
  METHODS
  EMBASE (including MEDLINE) and the Cochrane Library were searched. Studies conducted only within Asia, which reported multivariate analysis with a sample size of 200 or more subjects, were included.
  
  
  RESULTS
  A total of 32 studies were included. All six studies examining diabetes and fracture found that subjects with diabetes had a significantly higher risk of fracture than did subjects without diabetes (risk estimate range 1.26-4.73). Two studies found that subjects with atherosclerosis had a significantly higher risk of fracture (risk estimate range 1.10-2.52). Studies consistently reported that MetS is likely associated with osteoporosis or decreased BMD in men but not women. No consistent association was found for diabetes and BMD, with studies reporting contrasting results. There was limited evidence investigating lipid metabolism and hyperglycemia and risk of fracture or bone loss in Asian populations.
  
  
  CONCLUSIONS
  These findings suggest that diabetes is a risk factor for fracture in Asian populations. MetS may be associated with bone loss in Asian men and atherosclerosis associated with increased fractures; however, caution is needed interpreting these findings given limitations in study design.
authors.affiliation: Shimane University Faculty of Medicine, Internal Medicine 1, Shimane, Japan.
authors.forename: Toshitsugu
authors.initials: T
authors.lastname: Sugimoto
authors.affiliation: Eli Lilly Japan K.K., Lilly Research Laboratories, Kobe, Japan. Electronic address: sato_masayo@lilly.com.
authors.forename: Masayo
authors.initials: M
authors.lastname: Sato
authors.affiliation: Optum, Sydney, NSW, Australia.
authors.forename: Francis C
authors.initials: FC
authors.lastname: Dehle
authors.affiliation: Optum, Sydney, NSW, Australia.
authors.forename: Alan J M
authors.initials: AJ
authors.lastname: Brnabic
authors.affiliation: Optum, Sydney, NSW, Australia.
authors.forename: Adele
authors.initials: A
authors.lastname: Weston
authors.affiliation: Eli Lilly and Company, Global Health Outcomes, Indianapolis, IN, USA.
authors.forename: Russel
authors.initials: R
authors.lastname: Burge
mesh_terms: D001208:Asia; D015519:Bone Density; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D008019:Life Style; D008297:Male; D008659:Metabolic Diseases / Q000453:epidemiology*; D010024:Osteoporosis / Q000453:epidemiology*; D012306:Risk
keywords: atherosclerosis; fracture; metabolic disorders; metabolic syndrome; osteoporosis; type 2 diabetes