Does diabetes increase the risk of bone fractures?
Both type 1 and type 2 diabetes clearly and demonstrably increase the risk of bone fractures. If you have diabetes, discuss with your doctor whether your bone health is being properly monitored, as the standard risk score underestimates this risk.
Diabetes increases the risk of bone fractures. This applies to both type 1 and type 2 diabetes, and has been confirmed by multiple reviews and a meta-analysis of ten studies involving more than 1.2 million postmenopausal women. The increased fracture risks apply to multiple sites in the body, including the hip and the spine.
In type 1 diabetes, bone density is on average lower than in people without diabetes, which partly explains the higher fracture risk. In type 2, the picture is more surprising: bone density is normal or even slightly elevated, yet the fracture risk is still greater. This is because the internal architecture of the bone and its material properties are compromised. The outer bone layer contains more small pores, and the collagen network within the bone becomes more brittle due to harmful sugar-protein compounds that accumulate during prolonged periods of high blood sugar. A high bone density reading in someone with type 2 diabetes therefore gives a falsely reassuring picture.
Beyond bone quality, fall risk plays a major role. Nerve damage to the feet and legs, muscle loss, poor vision, and low blood sugar caused by medication all make people with diabetes more prone to falling. And when they do fall, they are also more likely to sustain a fracture. A longer duration of disease and poor blood sugar control are associated with an even higher fracture risk.
Some blood-sugar-lowering medications make matters worse. Thiazolidinediones, such as pioglitazone, have a direct negative effect on bone and increase fracture risk further. Two small studies suggest that bone-protective agents such as teriparatide and denosumab may also be effective in type 2 diabetes, but the evidence for this is still limited.
Anyone with diabetes who asks their doctor to assess their fracture risk should be aware that the widely used FRAX risk score underestimates the true risk in people with diabetes. Additional measurement of bone microstructure can improve the assessment. Discuss this with your doctor if you have diabetes and want your bone health evaluated.
All claims are based on reviews and one systematic meta-analysis (PMID 37543616). No randomised trials were included. The association between diabetes and fracture risk is consistent across multiple reviews; the mechanistic explanations (AGEs, bone microstructure) have been demonstrated predominantly at an associative level.
Does drinking a lot of coffee increase the risk of bone fractures?
For most people, coffee does not appear to be a proven cause of bone fractures, but for women who drink a lot of coffee some caution is reasonable; in that case, make sure to get enough calcium and vitamin D in your diet.
Does too little protein increase your risk of bone fractures as you age?
Yes, too little protein increases your risk of bone fractures in older age. This works through weaker bones as well as through poorer muscle condition. Aim for at least 1.0 to 1.2 grams of protein per kilogram of body weight per day, preferably together with adequate calcium and vitamin D.
Are there dietary patterns that have been proven to reduce bone fractures?
Fermented dairy, sufficient vegetables and fruit, and a varied diet with protein and calcium are best supported for bone protection, while soft drinks, alcohol and an overly narrow (vegan) diet without supplementation increase your fracture risk.
What does your balance have to do with preventing bone fractures?
Poor balance increases the risk of falling and therefore of bone fractures; targeted balance training can reduce that risk by tens of percentage points, especially when you practise for more than three hours per week.
Can eating disorders such as anorexia cause permanent bone damage?
Anorexia causes permanent bone damage in the majority of cases, particularly when the condition begins during adolescence. Discuss a bone assessment with your doctor if you or someone you know is affected by this.
Does being overweight affect your bone density?
Being overweight does not straightforwardly increase bone density, and the location and amount of fat strongly determine whether the skeleton benefits or is harmed. If you are considering losing weight, do so gradually and combine it with strength training to limit bone loss.