The effects of type 1 and type 2 diabetes mellitus on bone health in chronic kidney disease
Abstract
Fracture is an under-recognized but common complication of diabetes mellitus, with an incidence approaching twofold in type 2 diabetes mellitus (T2DM) and up to sevenfold in type 1 diabetes mellitus (T1DM) compared with that in the general population. Both T1DM and T2DM induce chronic hyperglycaemia, leading to the accumulation of advanced glycosylation end products that affect osteoblast function, increased collagen crosslinking and a senescence phenotype promoting inflammation. Together with an increased incidence of microvascular disease and an increased risk of vitamin D deficiency, these factors reduce bone quality, thereby increasing bone fragility. In T1DM, reduced anabolic stimuli as well as the presence of autoimmune conditions might also contribute to reduced bone mass and increased fragility. Diabetes mellitus is the most common cause of kidney failure, and fracture risk is exacerbated when chronic kidney disease (CKD)-related mineral and bone disorders are superimposed on diabetic changes. Microvascular pathology, cortical thinning and trabecular deterioration are particularly prominent in patients with T1DM and CKD, who suffer more fragility fractures than do other patients with CKD. This Review explores the pathophysiology of bone fragility in patients with diabetes mellitus and CKD and discusses techniques to predict fracture and pharmacotherapy that might reduce fracture risk.
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Diabetic patients typically exhibit systemic skeletal metabolic abnormalities, such as reduced bone density and compromised bone quality.
“Diabetic patients typically exhibit systemic skeletal metabolic abnormalities, such as reduced bone density and compromised bone quality2,3.”
From Microenvironment-responsive multifunctional enzyme-linked hydrogel for diabetic bone defect regeneration. (2025) · cites this paper as [3]
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Fu, X., Luo, Z., Guo, Y., Meng, W., Jin, S., Chen, J., Cai, Y., Luo, Z., Huang, C., Chen, A., et al. (2025) · Nature Communications · doi:10.1038/s41467-025-65165-5 · Cited by 44 · see citing works
“Diabetic patients typically exhibit systemic skeletal metabolic abnormalities, such as reduced bone density and compromised bone quality 2,3 .”
- Authors
- Aleksova, J., Ebeling, P., & Elder, G.
- Affiliations
- Hudson Institute of Medical Research (AU)
- Monash Health (AU)
- Garvan Institute of Medical Research (AU)
- Corresponding author
- Aleksova, Jasna
- Venue
- Nature Reviews Endocrinology
- Published
- 2025-01-16
- Volume
- 21
- Issue
- 5
- Pages
- 301-313
- ISSN
- 1759-5029 (ISSN-L)
- 1759-5037
- OpenAlex
- W4406429094
- Cited by
- 20
- References
- 169
- Citations by year
- 2026: 7 · 2025: 13
- FWCI
- 4.35
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- Locations
- Nature Reviews Endocrinology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Orthopedics and Sports Medicine › Bone health and osteoporosis research
- Health Sciences › Medicine › Nephrology › Parathyroid Disorders and Treatments
- Health Sciences › Medicine › Nephrology › Chronic Kidney Disease and Diabetes
- Keywords
- type 1 diabetes, type 2 diabetes, chronic kidney disease, bone health, fragility fractures, fracture risk, advanced glycation end products, hyperglycemia, osteoblast activity, collagen cross-linking, bone fragility, vitamin D deficiency, microangiopathy, cortical thinning, fracture prediction
- MeSH terms
- Bone and Bones, Diabetes Mellitus, Type 1, Diabetes Mellitus, Type 2, Humans, Bone Density, Fractures, Bone, Renal Insufficiency, Chronic
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