Does Diabetes Mellitus Increase the Risk of Avascular Osteonecrosis? A Systematic Review and Meta-Analysis

Wojciech Konarski (), Tomasz Poboży, Andrzej Kotela, Andrzej Śliwczyński, Ireneusz Kotela, Martyna Hordowicz and Jan Krakowiak
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Wojciech Konarski: Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
Tomasz Poboży: Department of Orthopaedic Surgery, Ciechanów Hospital, 06-400 Ciechanów, Poland
Andrzej Kotela: Faculty of Medicine, Collegium Medicum, Cardinal Stefan Wyszynski University in Warsaw, Woycickiego 1/3, 01-938 Warsaw, Poland
Andrzej Śliwczyński: Social Medicine Institute, (Department of Social and Preventive Medicine), Medical University of Lodz, 90-419 Lodz, Poland
Ireneusz Kotela: Department of Orthopedic Surgery and Traumatology, Central Research Hospital of Ministry of Interior, Wołoska 137, 02-507 Warsaw, Poland
Martyna Hordowicz: General Psychiatry Unit III, Dr. Barbara Borzym’s Independent Public Regional Psychiatric Health Care Center, 26-600 Radom, Poland
Jan Krakowiak: Social Medicine Institute, (Department of Social and Preventive Medicine), Medical University of Lodz, 90-419 Lodz, Poland

IJERPH, 2022, vol. 19, issue 22, 1-9

Abstract: Avascular osteonecrosis (AVN) is caused by the disrupted blood supply to the bone. Most AVN cases occur in the femoral head, but other sites might be affected as well, including the jaw or distal bones of the extremities. Previous studies suggested that diabetes could increase the risk of AVN of the jaw, but the relationship between diabetes and AVN in other bone sites is unclear. This systematic review and meta-analysis aimed to summarize the evidence from studies that had reported on the occurrence of AVN in sites other than the jaw, depending on the diagnosis of diabetes. Overall, we included 6 observational studies carried out in different populations: primary or secondary AVN of the femoral head, Takayasu arteritis, general population, kidney transplant recipients, systemic lupus erythematosus, and primary brain tumors. A random-effects meta-analysis showed that the risk of AVN in sites other than the jaw was non-significantly increased in patients with diabetes (odds ratio: 1.90, 95% confidence interval: 0.93–3.91). The pooled estimate increased and was significant after the exclusion of one study (2.46, 1.14–5.32). There was a significant heterogeneity (I 2 = 65%, tau 2 = 0.48, p = 0.01; prediction interval, 0.21–16.84). There was no significant publication bias ( p = 0.432). In conclusion, diabetes could increase the risk of AVN in sites other than the jaw, but the available evidence is limited. There is a need for large, well-designed, population-based studies.

Keywords: avascular osteonecrosis; bone necrosis; diabetes mellitus; AVN (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2022
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