| Usual age of diabetes onset | - Younger
- May affect peak bone mass
| - Older
- Usually maturity onset
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| BMI and influence on bone | - Historically lower, but now resembles the distribution in the general population
| - Usually high
- Increased load on skeleton
- Increased soft tissue may protect against impact
- Increased estrogen, leptin, and adiponectin production in adipose tissue; low testosterone levels in men
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| Other mechanism(s) of bone fragility | - Hyperglycemia may cause increased urine calcium loss and inhibit bone formation
- Abnormal bone microarchitecture (predominantly trabecular)
- Bone turnover is usually low
- Advanced glycation end products may embrittle bone material and adversely impact bone remodeling
| - Hyperglycemia may cause increased urine calcium loss and inhibit bone formation
- Abnormal bone microarchitecture (predominantly cortical)
- Bone turnover is usually low
- Advanced glycation end products may embrittle bone material and adversely impact bone modeling
|
| Other diabetes-related complications | - Micro- and macrovascular complications may increase fracture risk by effects on bone (eg, by metabolic effects of nephropathy) or by association with an increased risk of falling (eg, secondary to visual loss, hypoglycemia, cerebrovascular disease, or neuropathy). Neuropathy-related local bone loss may increase fracture risk at the foot and ankle (Charcot foot).
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