Does diabetes increase the risk of bone fractures?

Diabetes noticeably increases the risk of bone fractures, and this applies to both type 1 and type 2 diabetes. In a large prospective study, older women with type 2 diabetes had a 25 to 26% higher risk of a fracture, even after researchers accounted for age, weight, and bone density. In type 2 diabetes, the risk can be as much as three times higher depending on the bone location and the duration of the disease.

Remarkably, people with type 2 diabetes tend to have higher bone density on average than people without diabetes, yet that does not protect them. Standard tools for measuring bone strength underestimate the true fracture risk in people with diabetes. The main explanations lie elsewhere: chronically elevated blood sugar levels lead to the accumulation of harmful sugar-protein compounds in bone tissue, making bone more brittle despite normal density. In addition, the normal renewal of bone tissue proceeds more slowly in diabetes.

The physical consequences of the disease play an equally large role: in research, people with type 2 diabetes had nearly 10% less grip strength, walked nearly 10% more slowly, and had greater difficulty getting up from a seated position. This reduced muscle strength and balance means that falls more often result in a fracture. Long-standing diabetes, nerve damage, and poorer blood sugar control further increase this risk of falling.

The choice of certain diabetes medications also matters. Thiazolidinediones (a class of blood-sugar-lowering pills, including pioglitazone) have consistently been linked to more bone fractures. For GLP-1 receptor agonists such as semaglutide or liraglutide, a large Dutch study with more than 46,000 participants showed a modest but real 11% higher fracture risk compared with other diabetes medications. If you have diabetes and are concerned about your bone health, discuss which medication is appropriate for you with your doctor, especially if you already have an elevated risk of falling.