{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T14:40:47Z","timestamp":1787668847609,"version":"build-2736575974"},"reference-count":65,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,13]],"date-time":"2026-03-13T00:00:00Z","timestamp":1773360000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health and Care Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Diabet Med"],"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>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\u2010effects models. This study is registered with PROSPERO (CRD42024548795).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>This meta\u2010analysis 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\u2010regression 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>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\u2010specific risk assessment for individuals with T2D. However, due to the heterogeneity among studies, caution is required in the interpretation of these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/dme.70276","type":"journal-article","created":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T05:57:10Z","timestamp":1773467830000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Association between type 2 diabetes and site\u2010specific fracture risk: A systematic review and meta\u2010analysis of cohort studies including over 13 million participants"],"prefix":"10.1111","volume":"43","author":[{"given":"Sara","family":"Naderpour","sequence":"first","affiliation":[{"name":"Leicester Real World Evidence Unit, Diabetes Research Centre, College of Life Science University of Leicester  Leicester UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clare","family":"Gillies","sequence":"additional","affiliation":[{"name":"Leicester 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