Does diabetes cause osteoporosis? Diabetes is linked to osteoporosis, but not in a simple way. Type 1 diabetes is often linked to low bone mass. Type 2 diabetes is often linked to normal or even higher bone density, yet weaker bone and faster bone loss with age. In both types, the American Diabetes Association (ADA) says the risk of broken bones is higher, and a broken bone from a minor fall at age 65 or older counts as osteoporosis no matter what a bone scan shows.
Key takeaways
- The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) calls osteoporosis a "silent" disease because most people have no symptoms until a bone breaks.
- ADA's 2026 Standards of Care say type 1 diabetes is often linked to low bone mass, while people with type 2 diabetes tend to have 5% to 10% higher bone density but weaker bone structure.
- ADA says a low-trauma fracture of the hip, pelvis, spine, or forearm at age 65 or older is diagnostic of osteoporosis, regardless of bone density.
- ADA recommends a DXA bone scan every 2 to 3 years for adults with diabetes aged 65 and older, and for some younger adults with risk factors.
- Osteoporosis medicines work in people with type 2 diabetes about as well as in people without diabetes, according to ADA. Your clinician decides whether you need one.
What Is Osteoporosis?
NIAMS describes osteoporosis as a bone disease that develops when bone mineral density and bone mass decrease, or when the structure and strength of bone change. That raises the risk of fractures (broken bones).
NIAMS says fractures can happen in any bone but are most common in the hip, the spine, and the wrist. Bones can become so fragile that they break from a minor fall from standing height, or even from bending, lifting, or coughing.
Osteoporosis is the major cause of fractures in postmenopausal women and older men, according to NIAMS. NIAMS also says older men and women from all backgrounds are at risk.
How Does Type 1 Diabetes Affect Osteoporosis Risk?
ADA's 2026 Standards of Care say type 1 diabetes is often linked to low bone mass. Fractures tend to happen 10 to 15 years earlier than in people without diabetes. Hip fracture risk is 4.35 times higher.
ADA also says a bone density scan underestimates the fracture risk seen in younger people with type 1 diabetes. In one study cited by ADA, an average A1C above 7.9%, diabetes for more than 26 years, and a family history of fractures were each linked to higher risk of fractures outside the spine. Risk is also higher in people with nerve damage or other small blood vessel complications.
Because hip fracture risk in type 1 diabetes starts to climb after age 50, ADA says clinicians may consider a bone density test after age 50, or earlier after a low-trauma fracture or with other risk factors for bone loss.
How Does Type 2 Diabetes Affect Osteoporosis Risk?
Type 2 diabetes is where the link surprises many people. ADA says people with type 2 diabetes have 5% to 10% higher bone density than people without diabetes. But they also have:
- Lower bone strength
- Weaker bone structure (microarchitecture)
- Faster bone loss with age
Hip fracture risk is 1.79 times higher, and lifetime fracture risk is 40% to 70% higher, according to ADA. ADA also says low bone density is still a risk factor for fractures in type 2 diabetes. So higher density does not mean bones are safe.
ADA links longer diabetes to sugar-linked deposits in bone (advanced glycation end products), damage to small blood vessels, and inflammation, which may impair the cells that repair bone. ADA cites data showing significantly higher fracture risk in people who have had type 2 diabetes for more than 10 years.
| Question | Type 1 diabetes | Type 2 diabetes |
|---|---|---|
| Typical bone density | Often low | Often 5% to 10% higher |
| Bone quality | Affected | Lower strength and weaker structure |
| Hip fracture risk | 4.35 times higher | 1.79 times higher |
| When ADA suggests a bone test | Consider after age 50, or earlier with risk factors | Age 65 and older, or 50 and older with risk factors |
All figures above come from ADA's 2026 Standards of Care. Our hub guide explains how diabetes affects your bones in more detail.
What Other Risk Factors Matter?
NIAMS lists these risk factors for osteoporosis in the general population:
- Sex and age. Women have lower peak bone mass. Bone loss speeds up with age.
- Body size. Slender, thin-boned people have less bone to lose.
- Family history of osteoporosis or hip fracture.
- Hormone changes, such as low estrogen after menopause or low testosterone in men.
- Diet low in calcium, vitamin D, or protein, or excessive dieting.
- Other conditions, such as some hormone, digestive, and autoimmune diseases.
- Medicines taken long term, including glucocorticoids (steroids), some seizure medicines, some cancer medicines, proton pump inhibitors, SSRIs, and thiazolidinediones (TZDs), a class of type 2 diabetes medicines.
- Lifestyle, including low activity, heavy drinking, and smoking.
ADA adds diabetes-specific factors: frequent low blood sugar, diabetes for more than 10 years, use of insulin, TZDs, or sulfonylureas, an A1C above 8%, nerve, eye, or kidney damage, and frequent falls.
If you are in or past menopause, see our guide to diabetes and menopause. If you take steroids, see whether prednisone raises blood sugar.
What Are the Symptoms of Osteoporosis?
Usually none. NIAMS says you may not know you have osteoporosis until you break a bone. Signs of a spine (vertebral) fracture can include:
- Severe back pain
- Loss of height
- A stooped or hunched posture
Some spine fractures are found by accident. ADA says imaging done for other reasons, such as a CT scan, MRI, or chest x-ray, should be checked for spine fractures.
How Is Osteoporosis Diagnosed?
The most common test is a central DXA scan. NIAMS explains that DXA uses x-rays to measure calcium and other minerals, usually in the hip and spine. Results are given as:
- A T-score for postmenopausal women and men aged 50 and older. It compares your bone density with that of a healthy young adult. NIAMS says the lower your T-score, the higher your fracture risk.
- A Z-score for premenopausal women, men under 50, and children. It compares you with people of your age, ethnicity, and sex.
A T-score of −2.5 or lower is the traditional cutoff for osteoporosis. But ADA says other risk factors matter too. For people with type 2 diabetes:
- Experts have proposed reading a T-score of −2.0 the same way as −2.5 in a person without diabetes.
- FRAX, a calculator that estimates 10-year fracture risk, does not include type 2 diabetes and tends to underestimate risk.
ADA also 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. A low-trauma fracture is one from a fall from standing height or less.
Who Should Get a Bone Density Test?
ADA 2026 recommends a DXA scan every 2 to 3 years for adults with diabetes aged 65 and older and for younger adults with diabetes who have several risk factors. Table 4.4 in ADA's Standards lists postmenopausal women and men aged 50 and older with an adult fracture or with diabetes-specific risk factors.
The U.S. Preventive Services Task Force recommends a bone density test for women over 65 and for younger postmenopausal women at higher risk, according to NIAMS. NIAMS says more research is needed before the Task Force can make a recommendation for men, and encourages anyone worried about their bones to talk with their doctor.
Review your results with your clinician. NIAMS says any diagnosis or treatment plan should be based on your results, age, and other fracture risk factors. Our list of diabetes tests you may need each year can help you plan.
How Is Osteoporosis Treated in People With Diabetes?
ADA says treatment starts with the same steps used for everyone: enough protein, calcium, and vitamin D, no smoking, and regular aerobic, weight-bearing, flexibility, and balance exercise. See how to keep bones strong with diabetes.
When those steps are not enough, ADA describes these classes of osteoporosis medicines:
- Antiresorptive medicines, which slow bone breakdown
- Bone-building (osteoanabolic) medicines, which help form new bone
- One dual-action medicine, which does both
ADA says data suggest these medicines work about as well in people with type 2 diabetes as in people without diabetes. ADA lists the situations where clinicians should consider them, such as a low T-score, a past fragility fracture, or a high FRAX score. Each medicine has its own safety issues, so the choice depends on your health, kidney function, and ability to keep a treatment schedule.
Your clinician, and sometimes a bone specialist, decides whether you need treatment and which kind. ADA also recommends considering bone health when choosing diabetes medicines, and avoiding TZDs and sulfonylureas when possible for people at high fracture risk. Never stop or change a medicine on your own.
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.
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.
Prompt appointment: Book a visit if you are losing height, have a stooped posture, have broken a bone after age 50, or are 65 or older and have never had a bone density test.
Frequently Asked Questions
Can type 2 diabetes cause osteoporosis?
Type 2 diabetes is linked to weaker bone, even though ADA says people with type 2 diabetes tend to have 5% to 10% higher bone density. ADA reports lower bone strength, weaker bone structure, faster bone loss with age, and 1.79 times higher hip fracture risk. A low-trauma fracture at 65 or older counts as osteoporosis.
Does type 1 diabetes cause low bone density?
ADA's 2026 Standards of Care say type 1 diabetes is often linked to low bone mass. Fractures tend to happen 10 to 15 years earlier than in people without diabetes, and hip fracture risk is 4.35 times higher. ADA says a bone scan underestimates fracture risk in type 1 diabetes.
Can you have osteoporosis with a normal bone scan?
Yes. ADA says a low-trauma fracture of the hip, pelvis, spine, or forearm at age 65 or older is diagnostic of osteoporosis regardless of bone density. For type 2 diabetes, experts have proposed reading a T-score of minus 2.0 the same way as minus 2.5 in people without diabetes.
Which diabetes medicines are linked to bone loss?
NIAMS lists thiazolidinediones among medicines that can cause bone loss. ADA says thiazolidinediones and sulfonylureas are linked to higher fracture risk and that metformin has a safe bone profile. Never stop or switch a medicine on your own. Ask your care team whether your medicines fit your fracture risk.
Do osteoporosis medicines work for people with diabetes?
ADA says data suggest osteoporosis medicines work about as well in people with type 2 diabetes as in people without diabetes. ADA notes that no similar studies have been published for type 1 diabetes. Your clinician decides whether you need treatment and which kind.
How often should people 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, and for younger adults with diabetes who have several risk factors. ADA notes that the evidence on how often to repeat the test is less strong.
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. “Preventing Another Broken Bone.” Accessed October 2026.
- Ma L, Oei L, Jiang L, et al. “Association Between Bone Mineral Density and Type 2 Diabetes Mellitus: A Meta-Analysis of Observational Studies.” European Journal of Epidemiology. 2012;27(5):319–332. Historical context only. Accessed October 2026.
Next Steps
If you are 65 or older, or 50 or older with diabetes risk factors, ask your clinician at your next visit whether you are due for a bone density test. Bring a list of past broken bones, falls, and every medicine you take.
For adults with type 2 diabetes or prediabetes who want lifestyle education alongside clinical care, the Done With Diabetes™ program focuses on lifestyle changes for type 2 diabetes, organizing 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.