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Diabetes Linked to Bone Deterioration in Postmenopausal Women

Poor glycemic control compromises normal bone remodeling and can increase risk of fracture

by Bianca Garilli, ND

Type 2 diabetes (T2D) is estimated to affect nearly 15 million adult women in the US.1 This chronic disease can lead to a host of medical concerns including detrimental effects on bone health, making T2D an independent risk factor for bone fractures.2

A study published in Menopause sought to assess the status of bone mass, bone microarchitecture, and factors associated with vertebral fracture in postmenopausal women with T2D.3 This is a particularly important research query to shed light on, since previous publications have reported bone density to often be, paradoxically, normal or high in patients with T2D.2 However, bone mass and density do not provide valuable, granular information on bone architecture, nor functional strength.

This has led researchers to hypothesize there may be an underlying distortion and weakening in the bone architecture in individuals with T2D, resulting in alterations of material and structural properties in bone that increase the risk of fracture.2 It has been postulated that poor glycemic control in patients with T2D increases advanced glycation end products (AGEs) in the bone matrix, affecting both the collagen network and the function of bone cells, consequently reducing the ability of the bone to remodel normally.3-4

To investigate these mechanisms and further contribute to the data on the topic, 285 females (average age 60.7 years + 6.9 years) with T2D were enrolled in the study.3 Bone mineral density (BMD) and trabecular bone score (TBS) were assessed using DXA.3 Additionally, participants underwent T8-S1 lateral spine radiographs, laboratory evaluations, and personal interviews to capture clinical risk factors based on the fracture risk assessment tool (FRAX).3

Noteworthy results and insights include:3

  • High frequency of low bone mass (63.2%) and deteriorated bone microarchitecture (72.6%) observed in postmenopausal women with T2D
  • Bone deterioration in this population was associated with vertebral fracture
  • Stronger association seen between TBS, FRAX, and TBS-adjusted FRAX and vertebral fracture, vs. BMD and vertebral fracture
  • Utilization of FRAX or TBS-adjusted FRAX offers low cost, easy-to-use tools for fracture risk assessment in postmenopausal women with T2D

Why is this Clinically Relevant?

  • Poor glycemic control compromises normal bone remodeling and increases risk of fracture
  • Postmenopausal women with T2D should be screened and tested for fracture risk
  • BMD is not the best, nor most sensitive, indicator of fracture risk in menopausal women with T2D
  • Alternative methods for fracture assessment such as FRAX or TBS-adjusted FRAX should be considered for an economical, and more accurate screening approach (than BMD)

Link to abstract


  1. National Diabetes Statistics Report 2017. Accessed October 19, 2018.
  2. Leslie WD, Rubin MR, Schwartz AV, Kanis JA. Type 2 diabetes and bone. J Bone Miner Res. 2012;27(11):2231-2237.
  3. Chen FP, Kuo SF, Lin YC, Fan CM, Chem JF. Status of bone strength and factors associated with vertebral fracture in postmenopausal women with type 2 diabetes. Menopause. 2018;26(2).
  4. Dede AD, Tournis S, Dontas I, Trovas G. Type 2 diabetes mellitus and fracture risk. Metabolism. 2014;63:1480-1490.

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