Systematic review and meta-analysis links Type 2 Diabetes to higher fracture risk across multiple anatomical sitesType 2 Diabetes Linked To Higher Fracture Risk Across All Body Sites

Diabetic medicine : a journal of the British Diabetic Association Published May 1, 2026 Study authors: Naderpour Sara, Gillies Clare, O'Riordan Paul, Fahimfar Noushin, Karimi Zahra, Khoramdad Malihe, Kha… PubMed ↗ DOI ↗ Editorial oversight: Dr. Lars van Dijk, PhD · Surgical, Procedural & Diagnostic

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Key Takeaway

Consider site-specific fracture prevention strategies for individuals with Type 2 Diabetes given increased risk.

This systematic review and meta-analysis assessed fracture risk in a large cohort of 13,074,868 individuals, comprising 2,644,443 people with Type 2 Diabetes and 10,430,425 without the condition. The primary outcome measured fracture risk at various anatomical sites, comparing those with the disease to those without it. The study design was a systematic review and meta-analysis rather than a primary randomized trial.

The analysis reported a 25% increased risk for all anatomical sites, with a hazard ratio of 1.25 and a 95% CI of 1.20 to 1.31. Specifically, appendicular lower limb fractures showed a hazard ratio of 1.43 with a 95% CI of 1.30 to 1.57. Upper limb fractures had a hazard ratio of 1.29 and a 95% CI of 1.16 to 1.45. Osteoporotic or fragility fractures were associated with a hazard ratio of 1.14 and a 95% CI of 1.02 to 1.28. Women with Type 2 Diabetes demonstrated a significantly higher fracture risk than men, though specific effect sizes for this comparison were not reported.

The authors noted heterogeneity among studies as a key limitation. They emphasized that caution is required in the interpretation of these findings due to this heterogeneity. The practice relevance highlights the importance of targeted fracture prevention strategies and site-specific risk assessment for individuals with Type 2 Diabetes. No adverse events or discontinuations were reported in the safety data.

A large systematic review and meta-analysis examined fracture risk in over 13 million individuals, including more than 2.6 million people with Type 2 Diabetes. The researchers compared these patients to those without the condition to see how diabetes affected bone safety.

The study found that people with Type 2 Diabetes had a 25 percent higher overall risk of fractures compared to those without the disease. This increased risk was seen for fractures in the arms, legs, hips, and other specific bone sites. Additionally, the data showed that women with Type 2 Diabetes faced a significantly higher fracture risk than men.

Because the studies included in this analysis varied in how they measured risk, experts advise caution when interpreting these results. While the link between diabetes and fractures is clear, the differences in study methods mean that targeted prevention strategies are needed. This research highlights the importance of assessing fracture risk specifically for individuals with Type 2 Diabetes.

What this means for you:

People with Type 2 Diabetes have a higher risk of fractures, especially women, so targeted prevention is important.

Study Details

Study typeMeta analysis

EvidenceLevel 1

PublishedMay 2026

PMID41830104

View Original Abstract ↓

OBJECTIVE: This review aimed to quantify the association between Type 2 Diabetes (T2D) and the risk of fracture at various anatomical sites by synthesising data from cohort studies. METHODS: A systematic search was conducted across Medline, Embase, CINAHL and Web of Science databases, from inception to 10 June 2025. We estimated pooled hazard ratios (HRs) with corresponding 95% confidence intervals using random-effects models. This study is registered with PROSPERO (CRD42024548795). RESULTS: This meta-analysis of 22 studies, selected from 6534 screened studies, assessed a total of 13,074,868 individuals (2,644,443 people with T2D and 10,430,425 without T2D). People with T2D have a 25% increased risk of fractures (all anatomical sites) compared to individuals without T2D (HR: 1.25; 95% CI: 1.20 to 1.31). T2D was significantly associated with an increased risk of appendicular lower limb fractures (HR: 1.43; 95% CI: 1.30 to 1.57), upper limb fractures (HR: 1.29; 95% CI: 1.16 to 1.45), osteoporotic/fragility fractures (HR: 1.14; 95% CI: 1.02 to 1.28) and appendicular unspecified fractures (HR: 1.25; 95% CI: 1.05 to 1.48). Subgroup analyses indicated stronger associations in prospective studies. Women with T2D had a significantly higher fracture risk than men. Meta-regression analyses showed that a higher percentage of women participants and a longer duration of T2D were associated with stronger associations between T2D and fracture risk, particularly for lower limb fractures. 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.

Systematic review and meta-analysis links Type 2 Diabetes to higher fracture risk across multiple anatomical sitesType 2 Diabetes Linked To Higher Fracture Risk Across All Body Sites

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Systematic review and meta-analysis links Type 2 Diabetes to higher fracture risk across multiple anatomical sitesType 2 Diabetes Linked To Higher Fracture Risk Across All Body Sites

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