Are diabetics more likely to break bones? Yes. The American Diabetes Association (ADA) says people with type 1 or type 2 diabetes have a 34% higher risk of fractures (broken bones) than people without diabetes. Weaker bone quality, falls, low blood sugar, diabetes complications, and some medicines all play a role. Many of these risks can be lowered.
Key takeaways
- ADA's 2026 Standards of Care say hip fracture risk is 4.35 times higher in type 1 diabetes and 1.79 times higher in type 2 diabetes.
- Falls cause most hip fractures. The Centers for Disease Control and Prevention (CDC) says falls caused 83% of hip fracture deaths in older adults.
- ADA links low blood sugar, higher A1C, nerve and eye damage, and frequent falls to higher fracture risk.
- ADA says some diabetes medicines are linked to more fractures. Never stop or switch a medicine on your own; ask your care team instead.
- After one broken bone, the risk of another is highest in the next 1 to 2 years, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).
Which Bones Are People With Diabetes More Likely to Break?
ADA's 2026 Standards of Care report these risks compared with people without diabetes:
| Fracture | Type 1 diabetes | Type 2 diabetes |
|---|---|---|
| Any fracture | 34% higher risk across both types | 34% higher risk across both types |
| Hip | 4.35 times higher | 1.79 times higher |
| Spine (vertebra) | Not reported separately | 35% higher in one meta-analysis |
| Upper limb | 1.83 times higher | Higher |
| Ankle | 1.97 times higher | Higher |
ADA says people with type 1 diabetes tend to break bones 10 to 15 years earlier than people without diabetes. In type 2 diabetes, ADA says lifetime fracture risk is 40% to 70% higher. These are population figures from large studies. They do not predict what will happen to any one person.
Why Are People With Diabetes More Likely to Break Bones?
There are two main reasons: bones that are less strong, and falls that are more likely.
Bone quality. ADA says people with type 2 diabetes often have normal or higher bone density, but weaker bone structure and faster bone loss with age. Long-term diabetes may lead to sugar-linked deposits in bone, damage to small blood vessels, and inflammation. Our hub guide explains how diabetes affects your bones.
Blood sugar. ADA cites a meta-analysis that found about 8% higher fracture risk for each 1% rise in A1C. In another study ADA cites, an A1C above 9% over 2 years in people with type 2 diabetes was linked to 29% higher fracture risk.
Low blood sugar. In the same meta-analysis, low blood sugar was linked to 52% higher fracture risk. A Japanese study ADA cites found more than double the fracture risk with severe lows. A low can cause dizziness, shakiness, or confusion, which can lead to a fall. See low blood sugar symptoms.
Complications. ADA says fracture risk is higher in people with heart disease, nerve damage, eye damage, kidney damage, poor physical function, and frequent falls. Nerve damage in the feet can make it harder to feel the ground. Eye damage can make it harder to see steps. See what diabetic neuropathy is.
How Do Falls Raise Fracture Risk?
Falls are the main path to a broken hip. The CDC's fall facts say:
- More than 1 in 4 adults aged 65 and older fall each year, but fewer than half tell their doctor.
- Falling once doubles your chances of falling again.
- Nearly 319,000 older adults are hospitalized for hip fractures each year.
- Falls caused 83% of hip fracture deaths and 88% of hip fracture emergency visits and hospital stays.
The CDC lists conditions that make falls more likely, including lower body weakness, low vitamin D, trouble with walking and balance, some medicines such as sedatives, vision problems, foot pain or poor footwear, and home hazards.
Several of these overlap with diabetes. Our guide to low blood sugar in older adults explains how lows and falls are connected.
Can Diabetes Medicines Raise Fracture Risk?
Some diabetes medicines are linked to more fractures, and others appear neutral. ADA's 2026 Standards of Care summarize the evidence this way:
| Medicine class | What ADA 2026 says about bones |
|---|---|
| Metformin | Safe bone health profile |
| Thiazolidinediones (TZDs) | Fracture risk about doubled in women after 1 to 2 years of use; risk fell after stopping |
| Sulfonylureas | 30% higher fracture risk, linked to faster bone loss and more lows |
| DPP-4 inhibitors | Neutral effect on bone |
| GLP-1 receptor agonists | Low doses likely neutral to helpful; data lacking for higher doses with faster weight loss |
| SGLT2 inhibitors | One canagliflozin trial (CANVAS) found more fractures (2.7% vs. 1.9%), but later analyses found a neutral effect; other medicines in this class have not been linked to bone harm |
| Insulin | Linked to double the risk of hip fracture, likely because of lows, longer diabetes, and other health problems |
ADA recommends that clinicians consider bone health when choosing diabetes medicines and avoid TZDs and sulfonylureas when possible for people at high fracture risk. ADA also says aggressive treatment should be avoided in older and frail adults to prevent lows and falls.
These are decisions for you and your care team. Never stop, skip, or switch a medicine on your own. Bring your full medicine list to your next visit and ask how each one fits your fracture risk. NIAMS also suggests asking your doctor or pharmacist about medicines, including over-the-counter drugs, that cause tiredness or confusion. Our guide to what medications raise blood sugar covers other medicines to review.
What Happens After a Hip Fracture?
A hip fracture is serious for anyone, and ADA says it is harder for people with diabetes. ADA reports:
- About 20% of people do not survive 1 year after a hip fracture.
- About 60% do not regain their prior level of function.
- Hip fractures in people with diabetes are linked to higher death risk (28% higher in women and 57% higher in men), longer recovery, and slower healing.
ADA says a low-trauma fracture of the hip, pelvis, spine, or forearm at age 65 or older is diagnostic of osteoporosis, even with a normal bone scan. People with diabetes who have a fragility fracture should get a full workup and treatment to prevent more fractures. Our guide to whether diabetes causes osteoporosis explains this in more detail.
NIAMS says the risk of breaking another bone is highest in the year or two after the first break. It is important to start prevention steps soon. NIAMS also says avoiding exercise after a fracture can lead to more bone and muscle loss. Your doctor may refer you to a physical therapist for a safe exercise plan.
How Can You Lower Your Risk of Breaking a Bone?
Start with the steps ADA and NIAMS recommend:
- Ask about a bone density test. ADA recommends one every 2 to 3 years for adults with diabetes aged 65 and older, and for some younger adults with risk factors.
- Talk about lows. ADA says blood sugar goals should be set for each person at high fracture risk, with medicines that have a low risk of lows when possible.
- Stay active. ADA recommends aerobic, weight-bearing, flexibility, and balance exercise. See exercise for older adults with diabetes.
- Get enough protein, calcium, and vitamin D. Ask your care team before starting supplements.
- Get your eyes checked. NIAMS suggests a doctor check your eyes at least once a year. See how often to get a diabetic eye exam.
- Limit alcohol and avoid tobacco. NIAMS says both can weaken bones.
NIAMS says most falls happen at home and lists simple safety fixes:
- Use nightlights around your home.
- Keep floors free of clutter.
- Wear supportive, low-heeled shoes with non-skid soles.
- Make sure rugs have skid-proof backing or are tacked down.
- Keep cords out of walkways.
- Light staircases well and add handrails on both sides.
- Install grab bars next to tubs, showers, and toilets.
- Keep a flashlight next to your bed.
Our guide to how to keep bones strong with diabetes covers food, exercise, and daily habits.
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 while taking a blood thinner. Call 911 for a low blood sugar if someone is unconscious or cannot swallow.
Same day: The CDC says an older adult who falls and hits their head should see a doctor right away. Also contact your care team the same day for sudden, severe back pain, which NIAMS lists as a possible sign of a spine fracture.
Prompt appointment: Book a visit if you have fallen in the past year, feel unsteady, have had lows that made you dizzy, or have broken a bone after age 50. Ask whether you need a bone density test and a medicine review.
Frequently Asked Questions
How much more likely are diabetics to break a bone?
ADA's 2026 Standards of Care say fracture risk is 34% higher in people with diabetes than in people without it. Hip fracture risk is 4.35 times higher in type 1 diabetes and 1.79 times higher in type 2 diabetes. These are population figures, not a prediction for one person.
Why do people with type 2 diabetes break bones if their bone density is normal?
ADA says people with type 2 diabetes often have normal or higher bone density but weaker bone structure and faster bone loss with age. Falls linked to low blood sugar, nerve damage, and eye problems also raise the risk. A bone scan can underestimate fracture risk in type 2 diabetes.
Which diabetes medicines are linked to fractures?
ADA says thiazolidinediones and sulfonylureas are linked to higher fracture risk, and insulin is linked to double the risk of hip fracture. Metformin has a safe bone profile, and DPP-4 inhibitors appear neutral. Never stop or switch a medicine on your own. Ask your care team how your medicines fit your fracture risk.
Do SGLT2 inhibitors cause broken bones?
ADA says one trial of canagliflozin, an SGLT2 inhibitor, found more fractures in people taking it than in those who were not, 2.7% vs. 1.9%. Later analyses from the same trial and another trial found a neutral effect. ADA says other SGLT2 inhibitors have not been linked to bone harm.
Do people with diabetes heal more slowly from a broken hip?
ADA says hip fractures in people with diabetes are linked to longer recovery, slower healing, and higher death risk, 28% higher in women and 57% higher in men. Starting prevention steps early matters, because NIAMS says the risk of another break is highest in the first 1 to 2 years.
How can someone with diabetes avoid falling?
NIAMS suggests nightlights, clutter-free floors, supportive low-heeled shoes with non-skid soles, secured rugs, handrails, and grab bars. ADA recommends balance and weight-bearing exercise and avoiding lows. The CDC says falling once doubles the chance of falling again, so tell your doctor about any fall.
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.
- Centers for Disease Control and Prevention. “Facts About Older Adult Falls.” 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. “Edwin Smith papyrus.” Historical context only. Accessed October 2026.
Next Steps
Walk through your home with the NIAMS safety list above and fix one hazard this week. Then write down any falls or dizzy lows from the past year and bring the list, with your medicines, to your next visit.
For adults with type 2 diabetes or prediabetes who want lifestyle education alongside clinical care, the Done With Diabetes™ program offers a type 2 diabetes protocol that organizes learning about meals, movement, sleep, and stress. It does not diagnose or treat fractures, osteoporosis, or diabetes, interpret test results, change medicines, or replace your care team.