Fracture risk in type 2 diabetes isn’t explained by bone loss alone

What happened: fracture risk in type 2 diabetes gets a new clue

A new Diabetes Care study reports that bone deterioration alone does not explain the higher fracture risk in type 2 diabetes seen in some older adults.

The paper—"Type 2 Diabetes and Longitudinal Changes in Cortical and Trabecular Bone Density, Microarchitecture, and Strength: The Framingham Study"—used a bone imaging approach to examine bone compartments and track changes over time.

• Study journal: Diabetes Care (2026)
• Study name: The Framingham Study analysis
• DOI: 10.2337/dc26-0846

What the evidence shows about fracture risk in type 2 diabetes

The study found that bone loss over time was similar in older adults with and without type 2 diabetes, despite expectations of greater deterioration in the diabetes group.

Lead author Alyssa B. Dufour, PhD, said the team used a “novel bone imaging device” to assess cortical bone (outer layer) and trabecular bone (inner, spongy bone), but did not observe greater changes in bone microstructure and strength in people with type 2 diabetes.

• Evidence type: peer-reviewed publication reporting longitudinal changes
• Population described in the source: older adults (with vs without type 2 diabetes)
• Main result reported: similar bone loss in both groups

Why fracture risk in type 2 diabetes can rise even with denser bones

The study adds to a long-noted paradox: people with type 2 diabetes often have denser bones yet are still more likely to experience fractures.

Senior author Elizabeth (Lisa) Samelson, PhD, said this paradox suggests bone density alone does not tell the whole story and supports looking at other factors that influence bone strength and fracture risk.

• Key point: bone density is not the only marker tied to fracture risk in type 2 diabetes
• Implication: clinicians and researchers may need broader ways to assess risk than bone density measures alone

Practical context for metabolic health: what to discuss if you have type 2 diabetes

For people managing metabolic health, this study supports the idea that fracture risk in type 2 diabetes may not be fully captured by bone loss measures alone.

A practical next step is to talk with your clinician about how fracture risk is assessed in your care plan and whether factors beyond bone density are being considered.

• Ask what your care team uses to estimate fracture risk
• Ask whether your assessment goes beyond bone density alone
• If you’ve had a fall or fracture, mention it so it’s included in your risk discussion

Limitations and what this study does not show

This report does not identify which “other factors” drive the higher fracture risk in type 2 diabetes; it mainly shows that measured bone loss was similar in older adults with and without type 2 diabetes.

The source summary does not provide effect sizes, detailed participant characteristics, or fracture outcomes, so readers should avoid assuming this result applies to all people with type 2 diabetes or explains every fracture.

• Does not pinpoint the non–bone-loss causes of higher fracture risk
• Details on magnitude of changes and broader generalizability are not provided in the source text
• Focus is on older adults, as described in the source