OBJECTIVES: Type 2 diabetes mellitus (T2DM) is a metabolic disorder characterised by hyperglycemia. T2DM associated with abnormal bone health and cause of increased risk of fracture even though patients (especially postmenopausal women) have normal or higher BMD. Therefore, aim of this systematic review and meta-analysis was to analyse association between risks of fracture and T2DM in postmenopausal women.

METHODS: A PubMed/MEDLINE, Web of Science and Cochrane library databases search was conducted for studies reporting T2DM and risk of hip and vertebral fracture in postmenopausal women published in English up to February 25, 2018. Adjusted estimates were used to calculate overall effect. Pooled hazard ratio (HR) and 95% confidence interval (CI) were calculated using a random-effect, generic inverse variance method. Two reviewers (MA and MA) independently assessed the quality of each study by using Newcastle-Ottawa Scale (NOS).

RESULTS: Of 725 identified studies, total 4 observational studies (cohort studies) conducted in Asia-Pacific region satisfying inclusion criteria were considered. 1 study conducted in Korea reported both hip and vertebral fracture, 1 study each conducted in Taiwan and Australia reported hip fracture, and 1 study conducted in Japan reported vertebral fracture in T2DM postmenopausal patients. Pooled results from meta-analysis shows that diabetic postmenopausal women was not associated with risk of hip fracture (HR 1.38; 95%CI 0.93–2.06; P = 0.11; I = 100%) and vertebral fracture (HR 1.32; 95%CI 0.73–2.37; P = 0.36; I = 80%). The NOS results showed that the average score was 7.7 (range 6–8).

CONCLUSIONS: Evidence from the studies conducted in Asia-Pacific region shows that postmenopausal women with T2DM are not associated with risk of hip and vertebral fracture. Further long term clinical studies are required to confirm possible association between diabetes mellitus and risk of fracture in postmenopausal women.