Fracture risk among individuals with type 2 diabetes mellitus (T2DM) has been increasingly recognized, yet the magnitude of risk across different anatomical sites remains uncertain. A systematic review and meta-analysis published in Diabetic Medicine evaluated the relationship between T2D and fracture risk using evidence from cohort studies.

The analysis included cohort studies identified through searches of Medline, Embase, CINAHL, and Web of Science from database inception through June 10, 2025. Pooled hazard ratios (HRs) and 95% confidence intervals were estimated using random-effects models. The review was registered with PROSPERO (CRD42024548795).

A total of 22 studies were included from 6534 screened records, comprising 13,074,868 individuals, including 2,644,443 people with T2D and 10,430,425 individuals without T2D. The analysis showed that individuals with T2D had a higher risk of fractures across all anatomical sites compared with those without T2D (HR 1.25; 95% CI 1.20-1.31).

Site-specific analyses indicated higher risks for appendicular lower limb fractures (HR 1.43; 95% CI 1.30-1.57), upper limb fractures (HR 1.29; 95% CI 1.16-1.45), osteoporotic or fragility fractures (HR 1.14; 95% CI 1.02-1.28), and appendicular unspecified fractures (HR 1.25; 95% CI 1.05-1.48). Subgroup analyses showed stronger associations in prospective studies. Women with T2D showed higher fracture risk than men. Meta-regression indicated that a higher proportion of women participants and longer T2D duration corresponded to stronger associations between T2D and fracture risk, particularly for lower limb fractures.