Sex Differences in Osteomyelitis of the Foot in Persons With Diabetes Mellitus: A Meta-Analysis

Osteomyelitis of the foot is a risk factor for amputation in persons with diabetes mellitus. There is some evidence to suggest that patient sex affects the risk of diabetes-related foot complications.

To examine the effect of sex on osteomyelitis risk in patients with diabetic foot disease.

Systematic searches of PubMed and the China National Knowledge Infrastructure were performed from inception through May 2020 using the terms "diabetic foot" and "osteomyelitis." Original research studies including persons with diabetes mellitus, diabetic foot disease, or ulcers as well as reports of osteomyelitis were included. Study quality was assessed according to the Newcastle-Ottawa Scale. The pooled odds ratio (OR) and 95% confidence interval (CI) for osteomyelitis were calculated by sex.

Nine (9) studies from 6 countries involving 2583 patients met the inclusion criteria for analysis. No significant publication bias was observed. The average age of patients was 65.2 years, and 32.03% of men and 30.0% of women were diagnosed with osteomyelitis. The pooled OR was 1.14 (95% CI, 0.94-1.38; P = .76). Regression analysis (t = -0.61; P > .561) showed no association between the incidence of osteomyelitis and ORs.

This meta-analysis suggests that patient sex does not affect the odds of having osteomyelitis among persons with diabetes and diabetic foot disease or ulcers.