How do you keep bones strong with diabetes? The American Diabetes Association (ADA) says the steps are the same ones used for everyone, with a few diabetes-specific additions: eat enough protein, calcium, and vitamin D, stay active with weight-bearing, strength, and balance exercise, stop smoking, avoid low blood sugar, and lower your risk of falls. Ask your care team about a bone density test and whether your medicines fit your bone health.
Key takeaways
- ADA's 2026 Standards of Care advise 1,000 to 1,200 mg of calcium a day from food or supplements, plus enough vitamin D and protein.
- The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) lists milk, cheese, yogurt, salmon, tuna, sardines, kale, turnip greens, tofu set with calcium, and fortified foods as calcium sources.
- ADA notes that a draft U.S. Preventive Services Task Force (USPSTF) recommendation cautions against vitamin D supplements, with or without calcium, to prevent first fractures in adults 60 and older. Ask before starting any supplement.
- NIAMS recommends weight-bearing, resistance, and balance exercise. If you have low bone density, talk to your provider before starting a new program.
- Avoiding lows matters too. ADA links low blood sugar to a 52% higher fracture risk.
Why Do Bones Need Extra Care With Diabetes?
ADA's 2026 Standards of Care say people with diabetes have a 34% higher fracture risk than people without diabetes. In type 2 diabetes, bone density can look normal or high while bone quality is lower. Low blood sugar, nerve damage, and vision problems can also make falls more likely.
Our hub guide explains how diabetes affects your bones. This guide focuses on what you can do day to day.
How Much Calcium Do You Need?
ADA advises 1,000 to 1,200 mg of calcium a day for people with diabetes, in line with general recommendations. NIAMS gives these daily amounts for adults:
| Group | Calcium per day | Vitamin D per day |
|---|---|---|
| Adults 19 to 50 | 1,000 mg | 600 IU |
| Men 51 to 70 | 1,000 mg | 600 IU |
| Women 51 to 70 | 1,200 mg | 600 IU |
| Adults over 70 | 1,200 mg | 800 IU |
Source: NIAMS, "Calcium and Vitamin D: Important for Bone Health." These are general targets. Your clinician may set different ones based on your health and kidney function.
NIAMS says the best food sources of calcium are milk and other dairy foods, such as cheese and yogurt. Other sources NIAMS lists include:
- Fish, such as salmon and tuna
- Small fish with bones, such as sardines and canned salmon
- Leafy green vegetables, such as kale and turnip greens
- Tofu set with calcium
- Foods with added calcium, such as some brands of juice, soymilk, oatmeal, and breakfast cereal
ADA says calcium can come from food, supplements, or both. For milk choices that fit a diabetes eating plan, see which milk is good for type 2 diabetes. For a shopping list, see what should be on a diabetic grocery list.
How Do You Get Enough Vitamin D?
NIAMS says vitamin D helps your body absorb the calcium from food and supports healthy muscles, which help with balance. NIAMS notes that not many foods have vitamin D. Sources it lists include:
- Fish, such as trout, salmon, tuna, and mackerel
- Most milk and some yogurts in the United States, which have added vitamin D
- Some breakfast cereals and orange juice with added vitamin D (check the label)
ADA says the best blood level of vitamin D is still debated. ADA also notes that a draft USPSTF recommendation cautions against vitamin D supplements, with or without calcium, to prevent first fractures in postmenopausal women and men aged 60 and older who live in the community. NIAMS advises talking with your health care provider before taking supplements.
So the safest path is to start with food and ask your care team whether a supplement makes sense for you. If you have a low T-score, a past fracture, or take medicine for osteoporosis, your clinician may give different advice.
Does Protein Matter for Bones?
Yes. ADA's 2026 Standards of Care say all people with diabetes should get enough protein, along with calcium and vitamin D. NIAMS lists a diet low in protein among the risk factors for osteoporosis.
Protein also supports muscle, which helps with balance and strength. If you take a GLP-1 medicine and are losing weight, see our GLP-1 protein intake guide and whether GLP-1 medicines cause muscle loss. If you have kidney disease, ask your care team how much protein is right for you.
What Exercise Is Best for Bone Health?
NIAMS describes three types of exercise for bones:
| Type | What it does | NIAMS examples |
|---|---|---|
| Weight-bearing | Puts force on bones that makes them work harder | Brisk walking, climbing stairs, dancing, racket sports |
| Resistance (strength) | Adds resistance so muscles work harder, which also puts healthy stress on bones | Weight machines, free weights, resistance bands, body-weight moves |
| Balance | Improves balance and helps prevent falls | Tai chi, walking backwards, step-ups, lunges, shifting your weight |
NIAMS cites U.S. Department of Health and Human Services guidance of 150 minutes of moderate activity each week plus strength training at least twice a week. Older adults should mix in balance training. ADA adds flexibility exercise.
Our guides to exercise for older adults with diabetes and cardio vs. strength training for diabetes offer more ideas.
How Can You Exercise Safely With Diabetes?
NIAMS says that if you have low bone density or osteoporosis, talk to your health care provider before starting a new exercise program. NIAMS suggests:
- Wearing shoes with good traction
- Keeping a sturdy chair nearby for balance
- Avoiding quick changes in direction
People with diabetes have a few extra things to plan for:
- Lows. If you take insulin or a sulfonylurea, ask your care team how to prevent lows during and after exercise. ADA links lows to higher fracture risk.
- Feet. Wear supportive shoes and check your feet after activity, especially if you have nerve damage. See how often to get a diabetic foot exam.
- Eyes and nerves. If you have eye or nerve damage, ask which activities are safe for you.
How Do Blood Sugar and Medicines Affect Your Bones?
ADA 2026 says good blood sugar management and fewer lows are key for bone health. ADA cites a meta-analysis that found about 8% higher fracture risk for each 1% rise in A1C, and 52% higher fracture risk with low blood sugar.
ADA recommends that, for people at high fracture risk, clinicians set blood sugar goals for each person and choose medicines with a low risk of lows when possible. ADA also says clinicians should consider bone health when choosing diabetes medicines. For example, ADA says metformin has a safe bone profile, while thiazolidinediones and sulfonylureas are linked to higher fracture risk.
Do not stop or switch any medicine on your own. Ask your care team at your next visit how your medicines fit your bone health. If you take steroid medicines, ask about bone protection too, because NIAMS lists long-term glucocorticoid use as a cause of bone loss.
What Daily Habits Help Your Bones?
NIAMS and ADA list these habits:
- Stop smoking. ADA advises all people with diabetes to stop smoking. See whether smoking affects blood sugar.
- Limit alcohol. NIAMS suggests no more than 2 drinks a day for men and 1 for women. See whether diabetics can drink alcohol.
- Get your eyes checked. NIAMS suggests a doctor check your eyes at least once a year.
- Make your home safer. NIAMS suggests nightlights, clutter-free floors, secured rugs, stair rails, and grab bars.
- Ask about a bone test. ADA recommends a bone density scan every 2 to 3 years for adults with diabetes aged 65 and older, and for some younger adults with risk factors.
Our guide to whether diabetics are more likely to break bones has a full home-safety list. Our guide to whether diabetes causes osteoporosis explains bone tests.
When Should You Get Help?
Emergency: Call 911 or go to the emergency room after a fall if you cannot get up, cannot put weight on a leg, have severe pain, or hit your head. Call 911 for a low blood sugar if someone is unconscious or cannot swallow.
Same day: Contact your care team the same day for sudden, severe back pain, which NIAMS lists as a possible sign of a spine fracture, or if a low during exercise made you fall or feel faint.
Prompt appointment: Book a visit before starting a new exercise program if you have low bone density, before starting calcium or vitamin D supplements, or if you have had a fall or broken bone in the past year.
Frequently Asked Questions
How much calcium should a diabetic have a day?
ADA's 2026 Standards of Care advise 1,000 to 1,200 mg of calcium a day for people with diabetes, from food, supplements, or both. NIAMS lists 1,000 mg for adults 19 to 50 and men 51 to 70, and 1,200 mg for women over 50 and men over 70. Ask your clinician what is right for you.
Should diabetics take vitamin D for their bones?
Ask your care team first. ADA says people with diabetes should get enough vitamin D, but notes that a draft USPSTF recommendation cautions against vitamin D supplements, with or without calcium, to prevent first fractures in adults 60 and older. NIAMS advises talking with your provider before taking supplements.
What foods help keep bones strong with diabetes?
NIAMS lists milk, cheese, yogurt, salmon, tuna, sardines, kale, turnip greens, tofu set with calcium, and foods with added calcium. For vitamin D, NIAMS lists trout, salmon, tuna, mackerel, and milk with added vitamin D. ADA also says people with diabetes need enough protein.
What is the best exercise for bones with diabetes?
NIAMS recommends a mix of weight-bearing exercise such as brisk walking, resistance exercise such as bands or free weights, and balance exercise such as tai chi. NIAMS cites guidance of 150 minutes of moderate activity a week plus strength training twice a week. Talk to your provider first if you have low bone density.
Can walking help bones if you have diabetes?
Brisk walking is one of the weight-bearing exercises NIAMS lists for bone health. Walking can also be part of the 150 minutes of weekly activity NIAMS cites. Adding strength and balance exercise gives more benefit. Wear supportive shoes and plan for lows if your medicines can cause them.
Do diabetes medicines affect bone health?
Some do. ADA says metformin has a safe bone profile, while thiazolidinediones and sulfonylureas are linked to higher fracture risk. ADA recommends that clinicians consider bone health when choosing diabetes medicines. Do not stop or switch a medicine on your own. Ask your care team at your next visit.
References
- American Diabetes Association Professional Practice Committee for Diabetes. “4. Comprehensive Medical Evaluation and Assessment of Comorbidities: Standards of Care in Diabetes—2026.” Diabetes Care. 2026;49(Suppl. 1). Accessed October 2026.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Calcium and Vitamin D: Important for Bone Health.” Accessed October 2026.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Exercise for Your Bone Health.” Accessed October 2026.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Preventing Another Broken Bone.” Accessed October 2026.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Osteoporosis.” Accessed October 2026.
- Encyclopaedia Britannica. “Tai chi chuan.” Historical context only. Accessed October 2026.
Next Steps
This week, add one calcium-rich food to a meal you already eat, and try one balance move from the NIAMS list with a sturdy chair nearby. At your next visit, ask about a bone density test and whether a supplement makes sense for you.
For adults with type 2 diabetes or prediabetes who want lifestyle education alongside clinical care, the Done With Diabetes™ program offers a holistic approach to diabetes type 2 that organizes learning about meals, movement, sleep, and stress. It does not diagnose or treat osteoporosis or diabetes, interpret bone or glucose test results, change medicines, or replace your care team.