Bone Health and Fracture Risk in Diabetes Mellitus

Diabetes mellitus exerts a multifaceted impact on skeletal integrity, leading to an elevated risk of fragility fractures in both type 1 and type 2 disease. Chronic hyperglycaemia promotes the accumulation of advanced glycation end products within bone collagen, impairing material properties and disrupting osteoblast and osteoclast function. Concomitant microvascular and neuropathic complications can compromise bone perfusion, alter mechanosensory feedback and increase fall risk. Patients with type 1 diabetes often exhibit reduced bone formation and lower areal bone mineral density, whereas those with type 2 may present with normal or increased density but inferior microarchitecture. Measurement of bone turnover markers has limited predictive utility, although glycated haemoglobin remains the most reliable clinical indicator of fracture propensity. Emerging imaging techniques, such as high-resolution peripheral quantitative computed tomography, reveal deficits in cortical thickness, trabecular microstructure and bone stiffness, pointing to subtle architectural deterioration not captured by dual-energy X-ray absorptiometry. Nutritional status, glycaemic control, vitamin D levels and secondary hyperparathyroidism represent modifiable factors. Recognition of skeletal fragility as a core diabetic complication underscores the need for updated screening guidelines and targeted interventions to optimise bone health and reduce fracture incidence globally.

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Bone Health and Fracture Risk in Diabetes Mellitus publication trend

The graph below shows the total number of articles in bone health and fracture risk in diabetes mellitus across all publications each year (not limited to Nature Index journals).

Technical terms

BMD: Bone mineral density; the amount of mineral per unit area or volume of bone.

aBMD: Areal bone mineral density measured by dual-energy X-ray absorptiometry.

vBMD: Volumetric bone mineral density assessed by three-dimensional imaging techniques.

HR-pQCT: High-resolution peripheral quantitative computed tomography; imaging of bone microarchitecture in peripheral sites.

Advanced glycation end products (AGEs): Glycated proteins or lipids that accumulate in tissues under chronic hyperglycaemia, impairing function.

Cortical porosity: The proportion of void spaces within cortical bone that weakens mechanical strength.

References

1. Contemporary Risk of Hip Fracture in Type 1 and Type 2 Diabetes: A National Registry Study From Scotland4. Journal of Bone and Mineral Research (2013).
2. Type 1 Diabetes and Osteoporosis: From Molecular Pathways to Bone Phenotype. Journal of Osteoporosis (2015).
3. Peripheral Neuropathy as a Component of Skeletal Disease in Diabetes. Current Osteoporosis Reports (2019).
4. Prevalence and determinants of osteoporosis in patients with type 1 and type 2 diabetes mellitus. BMC Endocrine Disorders (2014).
5. Biochemical Markers of Bone Fragility in Patients With Diabetes. The Journal of Clinical Endocrinology & Metabolism (2023).
6. Bone Microarchitecture and Strength in Long‐Standing Type 1 Diabetes. Journal of Bone and Mineral Research (2020).
7. The Effects of Type 1 Diabetes and Diabetic Peripheral Neuropathy on the Musculoskeletal System: A Case–Control Study. Journal of Bone and Mineral Research (2020).
8. Relationship between risk factors for impaired bone health and HR-pQCT in young adults with type 1 diabetes. Frontiers in Endocrinology (2023).