People with diabetes, especially type 2, are more likely to break a bone, even if their bone scans show normal or even above-average density. A new expert review published in Osteoporosis International helps explain why.
Researchers from the International Osteoporosis Foundation found that while people with type 2 diabetes often have higher bone mineral density (BMD), they also have weaker bone quality, especially as the disease progresses. That means the structure of the bone — its “architecture” — is compromised, making it more fragile and prone to fracture.
The review points to a diagnostic tool called trabecular bone score (TBS), which offers more detail about bone texture. TBS scores tend to be lower in people with diabetes, even when their bone density looks fine. However, abdominal fat common in type 2 diabetes can interfere with current TBS readings, something researchers hope to fix with a new version of the algorithm.
“Lower TBS values in people with (type 2 diabetes) may not necessarily indicate deteriorated bone structure, but rather reflect technical limitations in the measurement,” said lead author Professor Serge Ferrari of the University Hospitals of Geneva. “This is especially important for fracture risk prediction and treatment decisions.”
The review recommends updating how doctors assess bone health in people with diabetes and urges more awareness of “diabetic bone disease” in routine care.
The research was conducted by the IOF Bone and Diabetes Working Group and supported by the International Osteoporosis Foundation.