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World J Diabetes. Apr 15, 2026; 17(4): 116349
Published online Apr 15, 2026. doi: 10.4239/wjd.v17.i4.116349
Published online Apr 15, 2026. doi: 10.4239/wjd.v17.i4.116349
Umbrella review protocol type 2 diabetes mellitus and fracture risk
Wen-Hui Zou, Zi-Yu Zhou, Jia-Jun Jiang, Run-Ze Zhang, Jian-Wei Li, Department of General Practice, Central Hospital of Xiangtan (The Affiliated Hospital of Hunan University), Xiangtan 411100, Hunan Province, China
Ying-Qi Feng, Ru-Tong Wang, Clinical Anatomy and Reproductive Medicine Application Institute, Hengyang Medical School, University of South China, Xiangtan 421001, Hunan Province, China
Co-first authors: Wen-Hui Zou and Zi-Yu Zhou.
Author contributions: Zou WH and Zhou ZY contributed equally as co-first authors; Zou WH, Zhou ZY, Feng YQ, and Li JW contributed to conceptualization; Zou WH, Zhou ZY, Feng YQ, Wang RT, Jiang JJ, and Zhang RZ contributed to data organization; Zou WH, Zhou ZY, and Feng YQ contributed to data curation, resources, writing original draft (lead author), and formal analysis; Wang RT, Jiang JJ, and Zhang RZ contributed to writing original draft; Li JW contributed to methodology, project administration, supervision, review and editing. All authors contributed to investigation and approved the final version to publish.
Supported by Undergraduate Innovation Training Program of Hunan Provincial Department of Education, No. 202510555087.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Corresponding author: Jian-Wei Li, Associate Chief Physician, Clinical Assistant Professor (Honorary), Department of General Practice, Central Hospital of Xiangtan (The Affiliated Hospital of Hunan University), No. 120 Heping Road, Yuhu District, Xiangtan 411100, Hunan Province, China. xyljw119@126.com
Received: November 13, 2025
Revised: January 13, 2026
Accepted: March 10, 2026
Published online: April 15, 2026
Processing time: 156 Days and 14.4 Hours
Revised: January 13, 2026
Accepted: March 10, 2026
Published online: April 15, 2026
Processing time: 156 Days and 14.4 Hours
Core Tip
Core Tip: This umbrella review reveals the complex, site-specific relationship between type 2 diabetes mellitus (T2DM) and fracture risk. Contrary to the elevated risk for overall, non-vertebral, and ankle fractures, T2DM was associated with a significantly reduced risk of hip fracture. This paradoxical finding challenges conventional views and may be attributed to skeletal compensatory adaptations in T2DM, such as adaptive increases in bone density. The study underscores the necessity of moving beyond a generalized fracture risk assessment and developing individualized, site-specific prevention and management strategies for patients with T2DM.