Fracture risk in young and middle-aged adults with type 1 diabetes mellitus: A systematic review and meta-analysis.

Background: Type 1 diabetes mellitus (T1DM) is associated with skeletal fragility. While previous meta-analyses have demonstrated an increased risk of fracture in individuals with T1DM, little is known about fracture risk in T1DM, in the absence of age-related confounders.
Aims: To determine the risk of fracture in young and middle-aged adults with T1DM aged 18-50 years old.
Design: Systematic review and meta-analysis.
Data Sources: Ovid MEDLINE, PubMed, EMBASE, EBM reviews and relevant conference abstracts.
Study Inclusion Criteria: Studies of adults aged between 18-50 years with type 1 diabetes mellitus, with reported fracture outcomes.
Primary Outcomes: Incident or prevalent fracture.
Results: Six studies were included in the meta-analysis. A total of 1724 fractures occurred in 35 925 patients with T1DM and 48 253 fractures occurred in 2 455 016 controls. RR for all fractures was 1.88 (95% CI 1.52-2.32, P < .001). Fifty-six hip fractures occurred among 34 707 patients with T1DM and 594 hip fractures occurred in 2 295 177 controls. The RR of hip fractures was 4.40 (95% CI 2.58-7.50, P < .001). Females and males with T1DM had a RR of 5.79 (95% CI 3.55-9.44, P < .001) and 3.67 (95% CI 2.10-6.41, P < .001), respectively.
Conclusions: In the absence of age-related comorbidities, fracture risk remains significantly elevated in young and middle-aged adults with T1DM. Younger age does not mitigate against hip fracture risk in T1DM, and health professionals need to be aware of this risk. Further studies are needed to evaluate the mechanisms of fracture in T1DM.
(© 2018 John Wiley & Sons Ltd.)