Table 2. Correlations and results between diabetes mellitus type 2 and fragility fractures in the elderly population.

Cohorts with bold type consist of the unique four studies that support that T2DM is not an aggravating factor for the skeletal health of the elderly.

T2DM: type 2 diabetes mellitus, BMD: bone mineral density, BMI: body mass index

Author	Year	Country	Study type	Patients-Gender	Results
Schwartz et al [6]	2001	USA	Prospective cohort study	9.654- Female	T2DM is a risk factor for hip, proximal humerus, and foot fractures among older women, suggesting that fracture prevention efforts should be a consideration in the treatment of diabetes.
Ottenbacher et al [7]	2002	USA	Prospective cohort study	2.884- Male and Female	T2DM was associated with an increased risk for a hip fracture in older Mexican Americans, particularly subjects taking insulin.
Taylor et al [8]	2004	USA	Prospective cohort study	6.787- Female	Clinicians should be alert to factors (including T2DM) other than BMD that place older women at a high risk of hip fracture.
Strotmeyer et al [9]	2005	USA	Prospective cohort study	3.075- Male and Female	These results indicate that older white and black adults with T2DM are at higher fracture risk compared with nondiabetic adults with a similar BMD.
Gerdhem et al [10]	2005	Sweden	Retrospective cohort study	1.132- Female	Women with T2DM had no more lifetime fractures than women without the diabetic disease.
Dobnig et al [11]	2006	Austria	Prospective cohort study	1.664- Male and Female	T2DM does not increase the risk for hip or other non-vertebral fractures in nursing home patients.
Bonds et al [12]	2006	USA	Prospective cohort study	93.676-Female	Women with type 2 diabetes are at increased risk for fractures.
Sosa et al [13]	2009	Spain	Prospective cohort study	202-Female	The prevalence of vertebral, hip, and non-vertebral fractures did not increase in type 2 DM.
Schwartz et al [14]	2011	USA	Prospective observational study	16.885- Male and Female	The fracture risk was higher for diabetic patients for a given T-score and age or for a given FRAX score.
Reyes et al [15]	2014	Spain	Population-based cohort study	186.171-Male	Common co-morbidities including diabetes are independently associated with an increased risk of hip fracture in elderly men.
Napoli et al [16]	2014	Italy	Prospective cohort study	5.994-Male	The risk of non-vertebral fracture is 30% higher in men with diabetes for a given BMD. Men who take insulin have more than double the risk of fractures.
Martinez-Laguna et al [17]	2014	Spain	Population-based cohort study	171.931- Male and Female	Newly diagnosed T2DM patients are at a 20% increased risk of hip fracture even in the early stages of the disease.
Lee et al [18]	2015	USA	Prospective cohort study	2704- Male and Female	The current study shows that older women with T2DM have a significantly greater risk of incident fracture than those without T2DM.
Looker et al [19]	2016	USA	Prospective cohort study	4588- Male and Female	The diabetes–fracture relationship was stronger in Mexican Americans and non-Hispanic blacks. Pre-diabetes was not significantly associated with higher fracture risk.
Napoli et al [20]	2018	Italy	Prospective cohort study	5994-Male	T2DM was not associated with a higher prevalence or incidence of vertebral fracture in older men, even after adjustment for BMI and BMD.
Goldshtein et al [21]	2018	Israel	Population-based cohort study	87.224- Male and Female	This study confirms the higher fracture risk of osteoporotic patients with T2DM, as compared to osteoporotic patients without T2DM.
Guo et al [22]	2020	China	Cross-sectional study	3430- Male and Female	Patients with T2DM have a higher risk for fractures even when they have sufficient BMD.