Association between type 2 diabetes and site‐specific fracture risk: A systematic review and meta‐analysis of cohort studies including over 13 million participants
Pooled result · Fractures (all anatomical sites)Result — go to the resultHazard ratio 1.25 95% CI 1.20–1.31Authors' conclusion
T2D is associated with an increased risk of fractures, especially in lower limbs (hip, ankle and foot). These findings highlight the importance of targeted fracture prevention strategies and site-specific risk assessment for individuals with T2D. However, due to the heterogeneity among studies, caution is required in the interpretation of these findings.
Study context
- Population
- Cohort studies of people with and without T2D; Medline, Embase, CINAHL and Web of Science searched from inception to 10 June 2025
- Participants
- 13,074,868 participants22 studies
- Comparison
- T2D vs no T2D
- T2Dn = 2,644,443
- Without T2Dn = 10,430,425reference
- Outcome
- Fracture risk (all anatomical sites and site-specific)
Methodological detailsrandom-effects models
- Random-effects models
Pooled result
Fractures (all anatomical sites)
Hazard ratio
1.25
95% CI 1.20–1.31
T2Dvs Without T2D
HR 1.25 (95% CI 1.20–1.31)
As reported in the abstract
Further pooled results
| Outcome | HR (95% CI) | |
|---|---|---|
| Appendicular lower limb fractures | 1.43 (1.30–1.57) | |
| Upper limb fractures | 1.29 (1.16–1.45) | |
| Osteoporotic/fragility fractures | 1.14 (1.02–1.28) | |
| Appendicular unspecified fractures | 1.25 (1.05–1.48) | |
| 0.512Hazard ratio (log scale) |
Subgroups and meta-regression
- Stronger associations in prospective studies
- Women with T2D had a significantly higher fracture risk than men
- Higher % women participants and longer T2D duration associated with stronger T2D–fracture associations, particularly for lower limb fractures
Original publication
Association between type 2 diabetes and site‐specific fracture risk: A systematic review and meta‐analysis of cohort studies including over 13 million participants. Diabet Med. Published 13 March 2026. doi:10.
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