Osteoporosis May Affect More than One-quarter of Persons with Type 2 Diabetes: Global Meta-analysis

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The worldwide prevalence of osteoporosis among persons with type 2 diabetes (T2D) may be higher than 1-in-4 according to findings from a new systematic review and meta-analysis of observational studies published online in BMC Endocrine Disorders on January 3, 2023.

Tapping data from 21 international studies comprising more than 11 000 individuals, the analysis found a pooled prevalence of osteoporosis of 27.67% with a range of prevalence among individual studies from 7.29% to 53.71%.

As worldwide incidence and prevalence of both diabetes and osteoporosis continue to escalate and the global population trends consistently older, a stage seems set for a perfect storm of future morbidity, mortality, and health care system burden. The meta-analysis authors, led by Qui Zhang, Department of Endocrinology, First Affiliated Hospital of Anhui Medical University, Hefei, China, suggest that their findings provide evidence for increased and enhanced surveillance of the osteoporosis-T2D overlap.

Although they cite a handful of more recent studies that have explored the relationship between osteoporosis and T2D and acknowledge some research on the association in specific populations, studies on worldwide prevalence are scarce, say Zhang and colleagues.

Their systematic review and meta-analysis was conducted to help build that evidence base and, they write, “to provide clinical guidance for prevention, diagnosis, and control strategies in light of the persistently rising prevalence of OP and DM.”

The investigators searched the PubMed, Embase, Medline, CBM, and Cochrane Library databases from inception until July 2022 without country or language barriers for full-text articles detailing observational studies. Screening yielded 143 full text articles as eligible and from those, investigators identified 21 for inclusion in their analysis.


Zhang et al note that the overall methodological quality of the included studies was high with none judged as low quality. Data related to 11 603 individuals was included among the 21 studies. The investigators reported a pooled prevalence of osteoporosis of 27.67% (95% CI, 21.37-33.98) among patients with T2D. Prevalence across studies ranged from 7.29% to 53.71% with subsequent heterogeneity testing indicating significant differences between studies (I2=98.5%, P<.001).

After meta regression analysis of predefined subgroups, the investigators found that osteoporosis prevalence was higher among those aged ≥60 years (29.61% [95% CI 21.97-37.24%]) than those aged <60 years (19.17% [95% CI 13.79-24.56%]) but they found no significant relationship between age at testing for osteoporosis prevalence in diabetes patients (P=.354). When gender was considered, the prevalence of OP was higher in studies with a higher proportion of women (32.96% [95% CI 25.90-40.02%]) than in those with lower proportion (23.01% [95% CI 16.09-29.92%]) but the difference did not reach statistical significance (P=.050).

The authors say their findings provide “direction for future studies on bone health” in persons with diabetes and note that many of the studies included in the analysis recommended population-based bone mineral density screening in patients with diabetes. The finding that more than 1-in-4 persons with T2D may have osteoporosis, they add, makes a compelling case for action to more urgently assess and manage the bone loss in those patients.

They note that such efforts would include “the improvement of access to laboratory testing, training of professionals for [osteoporosis] management, and facilitation of access to comprehensive therapy for [osteoporosis] and [type 2 diabetes mellitus].”

Reference: Zhang Q, Liu L, Chen F, Liu X. Prevalence of osteoporosis in patients with diabetes mellitus: a systematic review and meta-analysis of observational studies. BMC Endocr Disord. 2023;23:1. doi:10.1186/s12902-022-01260-8