Osteoporosis and Fracture Risk in Diabetes: Updated Clinical, Hormonal and Molecular Insights

A special issue of Diabetology (ISSN 2673-4540).

Deadline for manuscript submissions: 31 March 2026 | Viewed by 1297

Special Issue Editor


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Special Issue Information

Dear Colleagues,

We invite you to contribute to one or multiple articles, either an original study, an updated review (systematic or narrative) or other types of analyses, regarding the complex landscape of bone and related muscle involvement in diabetes mellitus type 1 or 2 or secondary diabetes, as found in various endocrine and non-endocrine conditions such as functioning adrenal tumors, neoplasia-related excess of pituitary hormones, pancreatic anomalies, parathyroid tumors, and corticotherapy.

We are particularly interested (but not exclusively) in the following domains/cross-domains or trans-disciplinary approaches:

  • Traditional and new tools to estimate the fracture risk in various diabetic subpopulations;
  • Anti-fracture intervention from standard drug regime to novel agents (antiresorptive or osteoanabolic) in individuals confirmed with diabetes;
  • The fracture risk which is correlated with using new classes of medication against diabetes and obesity (current level of statistical evidence, controversies, pitfalls);
  • Biomarkers of bone and muscle involvement in various diabetic subgroups (myokines, adipokines, inflammatory markers, bone resorption markers, bone formation markers, etc.);
  • Rehabilitation, fracture healing and non-pharmacologic intervention for primary and secondary fracture prevention in diabetic subjects;
  • New pathogenic loops in the bone-muscle-fat-gut cross-talk.

Dr. Mara Carsote
Guest Editor

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Keywords

  • diabetes mellitus
  • endocrine
  • hormone, bone
  • fracture
  • fracture risk assessment
  • skeleton
  • fracture healing
  • anti-osteoporotic drugs
  • osteoanabolic agents
  • FRAX
  • FRAXplus
  • bone turnover markers
  • mineral metabolism
  • DXA
  • osteoporosis
  • osteopenia
  • secondary diabetes
  • osteocalcin
  • muscle
  • irisin
  • collagen

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Published Papers (1 paper)

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Review

19 pages, 618 KB  
Review
Diabetic Bone Disease: A Comprehensive Narrative Review of Pathophysiology, Diagnosis, and Evidence-Based Management
by João Protásio Netto, Vagner Camargo Pires and Mariana Garcia Martins Castro
Diabetology 2025, 6(11), 140; https://doi.org/10.3390/diabetology6110140 - 11 Nov 2025
Viewed by 1071
Abstract
Background: Diabetic bone disease affects over 537 million people with diabetes worldwide, characterized by increased fracture risk despite paradoxically normal or elevated bone mineral density (BMD) in Type 2 diabetes. This narrative review synthesizes current evidence on pathophysiology, diagnostic approaches, and management [...] Read more.
Background: Diabetic bone disease affects over 537 million people with diabetes worldwide, characterized by increased fracture risk despite paradoxically normal or elevated bone mineral density (BMD) in Type 2 diabetes. This narrative review synthesizes current evidence on pathophysiology, diagnostic approaches, and management strategies. Methods: We performed a comprehensive literature search of the PubMed, Embase, and Cochrane databases (2007–2025), prioritizing systematic reviews, meta-analyses, large-scale population studies, and clinical trials examining bone health in diabetes, including bone density, quality, fracture risk, imaging techniques, biomarkers, and therapeutic interventions. Results: Advanced glycation end products fundamentally alter bone metabolism through mechanisms distinct from traditional osteoporosis. Type 1 and Type 2 diabetes produce contrasting skeletal phenotypes requiring tailored management. Recent umbrella reviews of 71 meta-analyses demonstrated skeletal benefits of metformin and GLP-1 receptor agonists, while confirming thiazolidinedione risks. Trabecular bone score enhances fracture prediction when DXA appears normal. Large-scale studies revealed heterogeneous risk patterns, with specific subgroups showing substantially elevated fracture risk. Advanced imaging revealed distinct microarchitectural changes between diabetes types. Diabetic patients experienced doubled healing complications, necessitating specialized perioperative protocols. Conclusions: Diabetic bone disease represents a distinct clinical entity requiring enhanced diagnostic strategies beyond traditional densitometry, evidence-based treatment selection considering skeletal and metabolic effects, and specialized management protocols extending beyond conventional osteoporosis care. Full article
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