A study using advanced imaging techniques suggests that the elevated risk of bone fractures in those with type 2 diabetes is more complex than previously thought, highlighting the need for comprehensive fracture risk assessments in diabetes care.
Type 2 diabetes is best known for its effects on blood sugar, the heart and the kidneys, but researchers have long suspected it also plays a role in bone fragility. A new study published in Diabetes Care adds to that picture by suggesting that the higher fracture risk seen in people with diabetes is not simply explained by faster age-related loss of bone structure. The work drew on participants from the Framingham Study, one of the United States’ best-known long-running health cohorts.
The researchers, led by Alyssa B. Dufour of the Hinda and Arthur Marcus Institute for Aging Research at Hebrew SeniorLife and Harvard Medical School, used specialised imaging to look beyond standard bone density testing. Routine scans can show whether bones are dense, but they do not fully capture the difference between the hard outer shell of bone and the inner, sponge-like network that also helps bones withstand stress. In people with type 2 diabetes, that distinction matters because bone density can look normal or even high while fracture risk remains elevated.
What the team found was more complicated than a simple story of accelerated bone ageing. Older adults with diabetes did not appear to lose the measured bone features more quickly than those without diabetes. Elizabeth Samelson, the study’s senior author, said the findings reinforce the idea that bone density alone does not explain why some people with diabetes break bones more often.
Earlier research helps explain why this remains an open question. Studies using high-resolution imaging have found that people with type 2 diabetes can have lower cortical bone density, greater cortical porosity and reduced bone strength despite apparently reassuring results on conventional scans. Other large studies have also shown that fracture risk is higher in people with newly diagnosed type 2 diabetes, including in the hip, spine and upper extremities.
That leaves several possible explanations. Long-term high blood sugar may alter the material quality of bone, including collagen, which helps give bone flexibility and resilience. Fractures may also be driven by factors outside the skeleton itself, such as nerve damage, poor vision, reduced muscle strength and falls. Previous Framingham research has identified age, sex, low body weight, prior falls, smoking, alcohol use and other illnesses as important contributors to fracture risk in people with diabetes.
The practical message is that diabetes care should not stop at glucose control. For older adults, a fuller assessment of fracture risk may need to include bone density, fall history, balance, eyesight, muscle strength, nerve problems and overall medical burden. The new findings do not rule out bone damage in diabetes, but they do narrow the search for what is really causing bones to break.
Disclaimer: This content is for informational purposes only and is not intended to be a substitute for professional medical judgment, advice, diagnosis, or treatment.
