Diabetes and Osteoporosis


  • Timothy John O’Leary, MD, FRCPC LMC Healthcare Ottawa


As part of our care of patients with diabetes, we monitor target organs for damage. We routinely screen for microvascular and macrovascular complications. In my opinion, the awareness of bones as a target organ of diabetes will improve the care that we provide to patients. Patients with both Type 1 (T1DM) and Type 2 (T2DM) are at increased risk of fractures. This will become a larger issue in the future as the prevalence of diabetes is rising and individuals with diabetes are living longer. In addition to skeletal factors, diabetes and its complications can increase fractures by increasing the patient’s propensity to fall. This can be due to neuropathy, visual impairment and hypoglycemia. However, there are some differences between the characteristics of bone disease between patients with T1DM and T2DM. 

Author Biography

Timothy John O’Leary, MD, FRCPC, LMC Healthcare Ottawa

Dr. Timothy O’Leary received his medical degree from Queen’s University, Kingston, Ontario in 1981. He trained in Internal Medicine in Toronto followed by an Endocrinology residency in the Ottawa/Kingston Program. He was an Assistant Professor at the University of Ottawa from 1985 to 2014 with a special interest in disorders of bone and mineral metabolism. Dr. O’Leary is currently in private endocrine practice with LMC Healthcare Ottawa. 


Shah VN, Shah CS, Snell-Bergeron JK. Type 1 diabetes and risk of fracture: meta-analysis and review of the literature. Diabet Med. 2015;32(9); 1134-42.

Schacter GI, et al. Diabetes and osteoporosis: Part 1 epidemiology and pathophysiology. Endicrinol Metab Clin N Am. 2021;50:275-85.

Moayeri A, et al. Fracture risk in patients with type 2 diabetes mellitus and possible risk factors, a systematic review and meta-analysis. Ther Clin Risk Manag. 2017;13:455-68.

Leslie WD, et al. Does diabetes modify the effect of FRAX risk factors for predicting major osteoporotic and hip fracture? Osteoporosis Int. 2014;25(12):2817-24.

Tang SY, Vashishtha D. The relative contributions of nonenzymatic glycation and cortical porosity on the, fracture toughness of aging bone. J Biomech. 2011;44(2):330-6.

Zhuang H, et al. Molecular mechanisms of PPAR-γ governing MSC osteogenic and adipogenic differentiation. Curr Stem Cell Res Ther. 2016;11(3):255-64.

Hidayat K, et al. The use of metformin, insulin, sulphonylureas and thiazolidinediones and the, risk, of, fracture: Systematic Review and meta-analysis of observational studies. Obes Rev. 2019;20(10):1494-503.

Ruanpeng D, et al. Sodium-glucose cotransporter 2 (SGLT2) inhibitors and fracture risk in patients with type 2 diabetes mellitus: a meta-analysis. Diabetes Metab Res Rev. 2017;33(6).

Tebe C, et al. The association between type 2 diabetes mellitus, hip fracture, and post-hip fracture mortality: a multi-state cohort analysis. Osteoporos Int,. 2019;30(12):2407-15.

Ferrari S, et al. Diagnosis and management of bone fragility in diabetes: an emerging challenge. Osteoporos Int.2018; 29(12):2585-96.

Schwartz AV, et al. Association of BMD and FRAX score with risk of fracture in older adults with type 2 diabetes. JAMA.2011;305(21):2184-92.

Leslie WD, et al. Does diabetes modify the effect of FRAX risk factors for predicting major osteoporotic and hip fracture? Osteoporos Int. 2014;25(12):2817-24.

Leslie WD, et al. TBS (trabecular bone score) and diabetes-related fracture risk. J Clin Endocrinol Metab.2013;98(2):602-9.

Giangregorio LM, et al. FRAX underestimates fracture risk in patients with diabetes, J Bone Miner Res. 2012;27(2):301-8.

Leslie WD, et al. Comparison of methods for improving fracture risk assessment in diabetes: the Manitoba BMD registry. J Bone Miner Res. 2018;33(11):1923-30.

Keegan TH, et al. Effect of alendronate on bone mineral density and biochemical markers of bone turnover in type 2 diabetic women: the Fracture Intervention Trial. Diabetes Care. 2004;27(7): 1547-53.

Anagnostis P, et al. Efficacy of anti-osteoporotic medications in patients with type 1 and 2 diabetes mellitus: a systematic review. Endocrine. 2018;60(3):373-83.

Ferrari S, et al. Denosumab in postmenopausal women with osteoporosis and diabetes: subgroup analysis of FREEDOM and FREEDOM extension. Bone.2020;134:115268.

Schwart AV, et al. Intensive glycemic control is not associated with fractures or falls in the ACCORD randomized trial. Diabetes Care. 2012 Jul;35(7):1525-31.




How to Cite

O’Leary, T. J. (2024). Diabetes and Osteoporosis. Canadian Diabetes & Endocrinology Today, 2(1), 27–31. Retrieved from https://CanadianDiabetesAndEndocrinologyToday.com/article/view/2-1-OLeary