Bones rarely complain. They don’t ache to announce they are becoming fragile, and for many people, the first unmistakable sign of a problem is a fracture. By then, the conversation about bone health is long overdue.
Calcium usually gets all the airtime. It matters, of course, but one of the more surprising findings in bone research suggests there is far more to the story: people with type 2 diabetes can have normal or even higher bone density than people without diabetes, and yet still face a higher risk of certain fractures (1).
This can sound like a contradiction. If a scan says the bones are dense, should they not be strong? Bone density is valuable information, but it cannot tell us everything about bone quality. It is a little like judging a building by how much concrete was used without knowing how well the structure was put together.
Researchers are investigating why diabetes seems to create this mismatch. Persistently high blood glucose may affect the collagen that helps give bone flexibility, while changes in the way bone renews itself may also play a role (1, 2). Then there are the circumstances surrounding a fall. Changes in vision or sensation in the feet can make a person less steady. A review of 30 studies found that type 2 diabetes was associated with a higher risk of fractures at sites including the hip and spine, although risk differed according to age and how long someone had lived with diabetes (3).
For The Noakes Foundation, this makes bone health part of a much bigger metabolic picture. Blood glucose does not exist in its own little box on a laboratory report. Its effects can reach tissues that rarely get mentioned when diabetes is discussed, including bone. The link between diabetes and fractures gives healthcare providers another reason to ask about bone health, even when a scan appears reassuring.
Food and movement have a place here too. A nourishing, whole-food approach needs to provide enough protein to support muscle and bone, as well as sources of calcium and other essential nutrients. Strong muscles and good balance can help reduce the likelihood of a fall (4). These are practical things to work on, alongside assessing individual fracture risk.
A fracture after a minor fall should not be filed under “bad luck” and forgotten. It is a chance to investigate what made the bone vulnerable in the first place and to prevent another break. That is the message behind the International Osteoporosis Foundation’s World Osteoporosis Day 2026 campaign: people who have had a fragility fracture need timely assessment and, where appropriate, treatment (4).
The link with type 2 diabetes makes that message all the more urgent. Bone health belongs on the list of things to discuss long before a fall brings it to anyone’s attention.
References
- Forner P, et al. Bone health in patients with type 2 diabetes. Journal of the Endocrine Society. 2024;8(7).
- Yamamoto M. Advanced glycation end products, diabetes, and bone strength. 2016.
- Moayeri A, et al. Fracture risk in patients with type 2 diabetes mellitus and possible risk factors: A systematic review and meta-analysis. 2017.
- International Osteoporosis Foundation. World Osteoporosis Day 2026 campaign toolkit.