Shah, Viral N.; DiMeglio, Linda A.
Diabetes is due primarily to insulin deficiency (type 1 diabetes, T1D) and/or insulin resistance (type 2 diabetes, T2D). Bone mineral density (BMD) is lower in persons with T1D, whereas higher in persons with T2D and obesity. Diabetes affects bone microarchitecture, leading to increased cortical porosity, lower trabecular number, and greater trabecular spacing. Diabetes also affects tissue material properties, in part, due to advanced glycation end product accumulation. Fracture risk is higher for persons with diabetes than healthy peers. Fracture likelihood depends on age of diabetes onset, disease duration, age, glycemic control, and presence of diabetes-related complications. BMD underestimates fracture risk. Although trabecular bone score improves fracture risk prediction in T2D, data are inadequate in T1D. Medications for blood sugar control that negatively affect bone (e.g., thiazolidinediones) should be avoided in persons with diabetes and increased fracture risk.