AACE Conference Coverage

Lower Bone Density and Higher Fracture Risk Linked to Type 2 Diabetes

Kate Young

Key Highlights:

  • Patients with type 2 diabetes (T2D) exhibited significantly lower bone mineral density (BMD) and higher fracture risk than non-diabetic individuals.
  • BMD and T-scores negatively correlated with both duration of diabetes and glycemic control.
  • Fracture risk assessments via FRAX confirmed a higher 10-year risk of major osteoporotic and hip fractures in the T2D cohort.

In a cross-sectional study presented at the American Association of Clinical Endocrinology Annual Meeting 2025, patients with type 2 diabetes (T2D) were found to have significantly lower BMD in the lumbar spine and femoral neck and markedly higher 10-year osteoporotic fracture risk scores compared to non-diabetic controls.

Although patients with T2D often present with normal or even elevated BMD, their actual fracture risk remains disproportionately high. This study aimed to elucidate the true impact of diabetes on bone integrity and fracture susceptibility, contributing essential insights for clinicians managing chronic diabetic complications.

The investigation enrolled 200 patients with T2D and 200 age and sex-matched healthy controls. Comprehensive clinical and laboratory evaluations were followed by DXA scanning to quantify BMD at the lumbar spine, hip, and femoral neck. Researchers utilized the WHO Fracture Risk Assessment Tool (FRAX) to estimate 10-year probabilities for major osteoporotic and hip fractures. Multivariate analyses, including Cox proportional hazards and linear regression, were conducted to explore the associations between bone metrics and diabetes-specific variables, such as disease duration, glycemic levels, and HOMA-IR.

Results revealed significantly lower BMD and T-scores in the diabetic cohort, particularly at the lumbar spine and femoral neck (P < .001). Furthermore, FRAX-derived 10-year fracture risk scores were markedly higher in individuals with T2D. Subgroup analyses showed a progressive decline in BMD and increase in fracture risk with longer diabetes duration and poorer glycemic control (P < .001). Regression analyses confirmed that insulin resistance was independently associated with both lower BMD and higher fracture risk, reinforcing the metabolic underpinnings of bone fragility in diabetes.

“Maintaining optimal glycemic control is paramount for preserving bone health,” the study authors concluded. “Therefore, osteoporosis prevention strategies should be an integral component of the comprehensive management plan for individuals with type 2 diabetes.”

Reference:
Almajali DA, Bhan V, Rao SD, Simon R. Breaking point: DEXA scan insights into bone mineral density and fracture risk in type 2 diabetes. Presented at: American Association of Clinical Endocrinology Annual Meeting; May 16–17, 2025; Orlando, FL. https://aace2025.d365.events/.