The Effect of Diabetes on Bone Structure and Fracture Risk: Insights from a Recent Review

A comprehensive review published in Osteoporosis International highlights the significant impact of diabetes mellitus on bone health and fracture susceptibility. The research, authored by experts including Professor Serge Ferrari, examines how diabetes alters bone microarchitecture, leading to increased fragility despite normal or even elevated bone mineral density (BMD) in many cases.

The review, titled "Bone microstructure and TBS in diabetes: what have we learned?" discusses the paradox observed in type 2 diabetes (T2DM): individuals often have higher BMD yet face a notably higher risk of fractures. Conversely, type 1 diabetes (T1DM) is typically associated with decreased BMD and compromised bone microarchitecture, especially in cortical and trabecular regions, heightening fracture risk.

Advanced imaging techniques reveal that T2DM patients frequently exhibit increased trabecular bone mass, but this is counterbalanced by increased cortical porosity and alterations in bone material properties. These structural changes, particularly in cortical bone, involve greater porosity and may be influenced by the accumulation of advanced glycation end-products (AGEs), which impair bone quality.

A critical tool discussed is the Trabecular Bone Score (TBS), an indirect measure derived from lumbar spine DXA scans, which assesses bone microarchitecture. The review emphasizes that TBS values tend to be lower in diabetic individuals, correlating with increased fracture risk. However, the presence of excess abdominal fat common in T2DM can artificially lower TBS readings due to current measurement limitations, necessitating algorithm updates that account for tissue thickness.

The authors advocate for integrating improved TBS algorithms and more longitudinal studies to better understand diabetic bone disease. They stress that routine clinical assessment should include such advanced diagnostic tools to more accurately predict fracture risk. Recognizing the microstructural changes parallels the importance of early intervention and tailored treatment strategies for diabetic patients.

In conclusion, this review signals a paradigm shift in understanding diabetic osteoporosis. It underscores the importance of comprehensive skeletal assessment beyond BMD, utilizing tools like TBS to enhance fracture risk prediction in people with diabetes and improve clinical outcomes.

Source: https://medicalxpress.com/news/2025-06-impact-diabetes-bone-health-fracture.html