Diabetes And Bone Health

Diabetes And Bone Health

What You Need to Know About Osteoporosis and Bone Fractures

If you’re among the more than 34 million Americans living with diabetes, you’re probably well aware of the increased risk you face for many diabetes-related complications. Common health issues related to diabetes include heart disease, nerve damage (neuropathy), eye complications (diabetic retinopathy), kidney disease, high blood pressure, and a host of other medical conditions.

However, there’s one complication that doesn’t seem to make as many headlines as those listed above and that’s the relationship between diabetes and bone health - specifically the development of osteoporosis.

What is osteoporosis?

While it’s entirely normal for all of us to lose a bit of bone density as we get older, osteoporosis is a condition where this deterioration goes well beyond normal. Specifically, osteoporosis is a medical condition in which the bones become less dense or “thinner” and far more likely to fracture.

According to the National Institute of Health, approximately 53 million people already have osteoporosis or are on the verge of developing it due to diminishing bone mass. Unfortunately, there are usually few warning signs of osteoporosis, and many people are not diagnosed until after their first fracture occurs.

The link between osteoporosis and diabetes

Diabetes is associated with a decrease in bone mass and, therefore, an increase in the risk of experiencing a fracture. This is particularly evident in individuals living with Type 1 diabetes. This form of the disease manifests at a young age when bones are still developing, and bone mass is still increasing. According to the National Institute of Health (NIH), it is very possible that people with Type 1 diabetes achieve a lower peak bone mass (the maximum density and strength that bones reach) as they come into adulthood. Peak bone mass is usually achieved somewhere in the early 20s and if this process is inhibited, a lower peak bone pass can increase the risk of developing osteoporosis later in life.

Risk factors for those with Type 2 diabetes

It might surprise you to find that many people with Type 2 diabetes, actually have normal or even above average bone density measurements. However, this doesn’t necessarily equate to good bone health, as you might logically think.

For starters, in many individuals this increase in bone mass is due to the fact that they are among the large population of Type 2 diabetics who also suffer from obesity. Carrying excess weight can reduce bone loss, however, it doesn’t necessarily equate to a lower risk of fractures or osteoporosis.

One big reason is that many with Type 2 diabetes also face a barrage of other diabetes-related complications, including nerve damage, muscle weakness, dizzying episodes of low blood sugar, and vision issues. All of these conditions make it far more likely for someone to experience a fall, which, naturally increases the risk of fracturing or breaking a bone.

Additionally, an article featured on EndocrineNews.com points out that there is evidence of subtle differences between the bones of those with diabetes and those without the disease. Tests show an increase in porosity in the bones in people with diabetes, which very well may weaken their bones even if bone density measurements are normal. This naturally contributes to the possibility of experiencing a fracture. 

What’s to blame for the decrease in bone quality among diabetics?

There are a lot of factors. However, a major culprit, according to the same Endocrine News post cited above, very well may be the accumulation of blood sugar (another reason why it is so important to test your blood sugar regularly and follow your doctor-prescribed insulin treatment and medication plan).

It’s possible that the proteins in collagen, which become encrusted in glucose when blood sugar levels rise, could be related to a lower bone strength in those with diabetes. Researchers conducted a study which used a skin test to measure sugar glycation and found a direct correlation between those with high glycation in the skin and weaker bone material quality.

Additional factors that can contribute to a weaking of the bones and/or an increased risk of fractures and developing osteoporosis, include:

A lack of physical activity

Being physically active not only helps keep blood sugar levels under control, but it is also important for healthy bones. Specifically, resistance exercises such as body-weight work, climbing stairs, and weightlifting can all contribute to bone and muscle strength. There’s the added benefit that stronger muscles usually equate to a lower risk of falls.

Insufficient Vitamin D

Vitamin D helps the body absorb calcium, which bones need to be healthy and strong. Most of us get plenty of Vitamin D from time spent outdoors in the sunshine. However, if you’re among the many with Type 2 diabetes who are also living a sedentary lifestyle, you might be missing out on this important vitamin your bones need to be healthy.

Having other diabetes-related complications

As we pointed out earlier, many health issues related to poor blood sugar control can contribute to a person experiencing dizziness and instability, thus increasing the likelihood they might experience a fall resulting in a fracture. Additionally, kidney damage often associated with diabetes may cause calcium, a key to good bone health, to be expelled in the urine.


Some oral medications prescribed to help lower blood sugar may also contribute to bone loss. Ask your doctor if you’re concerned about any medications, you might be taking.


Following a diabetes-healthy diet presents plenty of opportunities to load up on calcium and other healthy minerals. Be sure to include good sources of calcium, such as leafy green veggies and low-fat dairy products. Steer clear of sugars and limit carbohydrates.

Smoking and drinking

It’s no secret that smoking is bad for you, and bone health is definitely included in the long list of ways it can be detrimental. Additionally, excessive alcohol can also contribute to poor bone health.

Bone density testing

There is a test your diabetes physician can prescribe called a Bone Mineral Density test (BMD). This test measures bone density in different parts of the body, including the hip and the spine. A BMD test can detect osteoporosis before a bone fracture occurs. It can also help your doctor better predict your risk of developing osteoporosis down the road. This test is usually recommended at least twice a year for women 65 years or older, and men 70 years or older. However, if you’re younger and living with diabetes and are concerned about your bone health, ask your diabetes physician if a BMD test is right for you.

In the meantime, one of the best things you can do for bone health is maintain proper blood sugar control. Test regularly using a doctor-recommended glucose meter and test strips or a prescribed continuous glucose monitoring (CGM) system, and follow your treatment protocol, which might include insulin injections by syringe or insulin pen and other medications. 



Bone health is an often-overlooked aspect of living with diabetes. However, the more medicine learns, the more important adding fractures and osteoporosis to the list of possible complications becomes. After all, the key to treating any diabetes-related complication is identifying it as soon as possible.

Dr. Mishaela R. Rubin, Associate Professor of Medicine at Columbia University Medical Center in New York summed it up for Endocrine News stating, “I think it is important to emphasize the point that skeletal deterioration is another diabetic complication. We understand that patients who have poorly controlled diabetes are going to have worse bone quality.”


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