Does diabetes affect your bones? Yes. Both type 1 and type 2 diabetes are linked to a higher risk of broken bones. The American Diabetes Association (ADA) says people with diabetes have a 34% higher fracture risk than people without diabetes. In type 2 diabetes, this can happen even when a bone density test looks normal or high, because diabetes can affect the quality of bone, not just how dense it is.
Key takeaways
- ADA's 2026 Standards of Care say fracture risk is 34% higher in people with diabetes. In type 1 diabetes, hip fracture risk is 4.35 times higher. In type 2 diabetes, it is 1.79 times higher.
- People with type 2 diabetes tend to have 5% to 10% higher bone density, but ADA says their bones can still be weaker and lose strength faster with age.
- ADA links higher A1C, frequent low blood sugar, diabetes for more than 10 years, nerve, eye, or kidney problems, and frequent falls to higher fracture risk.
- ADA recommends a bone density scan (DXA) every 2 to 3 years for adults with diabetes aged 65 and older, and for some younger adults with risk factors.
- Protein, calcium, vitamin D, regular activity, balance work, and not smoking all support bone health. Ask your care team before starting supplements or changing any medicine.
How Does Diabetes Affect Your Bones?
Bones are living tissue. The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) explains that bones can weaken when bone mineral density (how much mineral is packed into the bone) drops, or when the structure of the bone changes. Either one makes broken bones more likely.
ADA's 2026 Standards of Care say diabetes can affect both. Over many years, diabetes may lead to:
- Sugar-linked deposits in bone. ADA says longer diabetes may be linked to advanced glycation end products, which form when sugar sticks to proteins, building up in the bone.
- Damage to small blood vessels. The same damage that can affect the eyes, nerves, and kidneys may affect bone.
- Ongoing inflammation.
ADA says these changes can impair the cells that build and repair bone. That may help explain why bones in people with diabetes can break more easily than their density alone would suggest.
Diabetes can also raise fracture risk in a second way: by making falls more likely. ADA notes that poor vision, nerve damage, muscle loss, gait problems, and low blood sugar can all lead to falls.
How Do Type 1 and Type 2 Diabetes Affect Bones Differently?
| What ADA 2026 reports | Type 1 diabetes | Type 2 diabetes |
|---|---|---|
| Bone density | Often lower than average | Often 5% to 10% higher than average |
| Hip fracture risk | 4.35 times higher | 1.79 times higher |
| Other fractures | Upper limb 1.83 times and ankle 1.97 times higher | 35% more spine fractures in one meta-analysis; upper limb and ankle risk also higher |
| When fractures happen | 10 to 15 years earlier than in people without diabetes | Lifetime fracture risk 40% to 70% higher |
| How well a bone scan predicts risk | A bone scan underestimates fracture risk | A bone scan and the FRAX risk calculator can underestimate fracture risk |
These numbers come from large studies of groups of people. They describe risk across a population, not what will happen to you. See our guide to type 1 vs. type 2 diabetes for more on how the two types differ.
Why Can Bones Look Dense but Still Break?
This is one of the most surprising parts of diabetes and bone health. ADA says people with type 2 diabetes tend to have 5% to 10% higher bone density, yet they have lower bone strength, weaker bone structure, and faster bone loss with age.
A standard bone density scan reports a T-score. NIAMS explains that the lower your T-score, the higher your fracture risk. But ADA says that for any given T-score and age, large studies found higher fracture risk in people with diabetes. For this reason, experts have proposed reading a T-score of −2.0 in a person with type 2 diabetes the same way as −2.5 in a person without diabetes.
ADA also notes that FRAX, a calculator doctors use to estimate 10-year fracture risk, does not include type 2 diabetes as a risk factor. It has been shown to underestimate risk in people with type 2 diabetes. Your clinician may adjust for this. Our guide to whether diabetes causes osteoporosis explains bone tests in more detail.
What Raises Bone Risk in Diabetes?
ADA lists these diabetes-specific risk factors as reasons for some adults aged 50 and older to get a bone density test:
- Frequent low blood sugar
- Diabetes for more than 10 years
- Taking insulin, thiazolidinediones (TZDs), or sulfonylureas
- An A1C above 8%
- Nerve damage (peripheral or autonomic neuropathy), eye damage (retinopathy), or kidney damage (nephropathy)
- Frequent falls
- Long-term use of glucocorticoid (steroid) medicines
Blood sugar. ADA cites a meta-analysis that found about 8% higher fracture risk for each 1% rise in A1C. In the same analysis, low blood sugar was linked to a 52% higher fracture risk. Our guide to low blood sugar in older adults explains why lows can lead to falls.
Complications. ADA says fracture risk is also higher in people with heart disease, nerve damage, eye damage, kidney damage, poor physical function, and frequent falls. See what diabetic neuropathy is and how often to get a diabetic eye exam.
Steroids. NIAMS lists long-term glucocorticoid use as a cause of bone loss. These medicines can also raise blood sugar. Our guide to whether prednisone raises blood sugar has more.
General risk factors. NIAMS also lists being female, older age, a small, thin frame, family history, low hormone levels, a diet low in calcium, vitamin D, or protein, low activity, heavy drinking, and smoking.
Can Diabetes Medicines Affect Your Bones?
Some can. ADA 2026 recommends that clinicians consider bone health when choosing diabetes medicines, especially for people at high fracture risk. ADA says:
- Metformin has a safe bone health profile.
- Thiazolidinediones (TZDs) were linked to about double the fracture risk in women after 1 to 2 years of use. NIAMS also lists TZDs among medicines that can cause bone loss.
- Sulfonylureas were linked to 30% higher fracture risk, partly because they can cause lows that lead to falls.
- DPP-4 inhibitors appear neutral for bone.
- GLP-1 receptor agonists at low doses appear neutral to helpful for bone, but data are lacking at higher doses with faster weight loss.
- Insulin has been linked to double the risk of hip fracture, likely because of lows, longer diabetes, and other health problems.
Never stop, skip, or switch a diabetes medicine on your own. If you are worried about your bones, ask your care team whether your medicines fit your fracture risk. Our guide to whether diabetics are more likely to break bones covers medicines and falls in more detail.
Should You Get a Bone Density Test?
ADA 2026 recommends that clinicians check fracture risk in older adults with diabetes as part of routine care. It also recommends a DXA scan every 2 to 3 years for:
- Adults with diabetes aged 65 and older
- Younger adults with diabetes who have several risk factors, such as postmenopausal women and men aged 50 and older with an adult fracture or the diabetes-specific risk factors above
NIAMS explains that DXA uses x-rays to measure the calcium and other minerals in your bones, usually at the hip and spine. ADA says that for type 1 diabetes, clinicians may consider a bone test after age 50, or earlier after a low-trauma fracture.
Ask about a bone test at your yearly visit. Our list of diabetes tests you may need each year can help you prepare.
How Can You Protect Your Bones?
ADA 2026 says bone protection for people with diabetes starts with the same steps used for everyone:
- Eat enough protein, calcium, and vitamin D. ADA advises 1,000 to 1,200 mg of calcium a day from food or supplements, plus vitamin D, in line with general recommendations.
- Stay active. ADA recommends regular aerobic activity plus weight-bearing, flexibility, and balance exercise.
- Stop smoking. See whether smoking affects blood sugar.
- Lower your risk of lows. ADA says blood sugar goals should be set for each person and that medicines with a low risk of lows are preferred for people at high fracture risk.
- Prevent falls. Keep up with eye exams, foot checks, and home safety.
ADA also notes that a draft recommendation from the U.S. Preventive Services Task Force (USPSTF) cautions against vitamin D supplements, with or without calcium, to prevent first fractures in adults 60 and older who live in the community. Talk to your care team before starting any supplement.
Our guide on how to keep bones strong with diabetes turns these steps into a daily plan. For a wider view of diabetes care later in life, see how to manage diabetes in older adults.
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 if you have sudden, severe back pain. NIAMS lists severe back pain as a possible sign of a spine fracture.
Prompt appointment: Book a visit if you have fallen recently, are losing height, have a stooped posture, have had a broken bone after age 50, or have any of the ADA risk factors above. Ask whether you need a bone density test.
Frequently Asked Questions
Does diabetes make your bones weaker?
It can. ADA 2026 says diabetes may affect bone quality through sugar-linked deposits in bone, damage to small blood vessels, and inflammation. People with type 2 diabetes often have normal or high bone density but still have weaker bone structure and faster bone loss with age. Fracture risk is 34% higher overall.
Which type of diabetes is worse for bones?
ADA reports that hip fracture risk is 4.35 times higher in type 1 diabetes and 1.79 times higher in type 2 diabetes. People with type 1 diabetes often have lower bone density and break bones 10 to 15 years earlier. Both types raise fracture risk, so both need attention.
Why can a normal bone scan miss risk in diabetes?
A bone scan measures bone density, not bone quality. ADA says people with type 2 diabetes have higher fracture risk than people without diabetes at the same T-score and age. Experts have proposed reading a T-score of minus 2.0 in type 2 diabetes like minus 2.5 in people without diabetes. Your clinician decides how to read your results.
Does high blood sugar affect your bones?
ADA cites a meta-analysis that found about 8% higher fracture risk for each 1% rise in A1C. ADA also lists an A1C above 8% as a reason some adults aged 50 and older may need a bone density test. Ask your care team what A1C goal is right for you.
Can low blood sugar lead to broken bones?
Low blood sugar can cause dizziness and falls. ADA cites a meta-analysis in which low blood sugar was linked to a 52% higher fracture risk. ADA recommends that people at high fracture risk have blood sugar goals set for them and medicines with a low risk of lows when possible.
When should someone with diabetes get a bone density test?
ADA 2026 recommends a DXA scan every 2 to 3 years for adults with diabetes aged 65 and older. It also recommends testing for some adults aged 50 and older with risk factors such as diabetes for more than 10 years, insulin use, an A1C above 8%, frequent lows, or frequent falls.
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. “Osteoporosis.” Accessed October 2026.
- National Institute of Arthritis and Musculoskeletal and Skin Diseases. “Bone Mineral Density Tests: What the Numbers Mean.” 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.
- Encyclopaedia Britannica. “Wolff’s law.” Historical context only. Accessed October 2026.
Next Steps
Write down your diabetes risk factors from the list above, any falls in the past year, and every medicine you take. Bring the list to your next visit and ask whether you need a bone density test.
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 type 2 diabetes 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.