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Diabetes and osteoporosis

By Dr. Susan E. Brown, PhD

With World Diabetes Day on November 14, this is an ideal time to take a look at what osteoporosis and diabetes have in common. It’s a lot more than you may realize!

High blood sugar and high insulin levels damage bone

Scientists are untangling a multitude of ways in which high blood sugar and high insulin levels damage bone, including:

  • Suppressing bone turnover. Insulin has been known to contribute to the bone remodeling process for a number of years (Rosen & Motyl, 2010). But when insulin is present in excessive amounts (as in type 2 diabetes), bone resorption and circulating levels of osteocalcin both decrease — within hours of an insulin surge, according to a recent study (Ivaska et al., 2015).
  • Increasing inflammation. Hyperglycemia has been found to increase oxidative stress, which in turn promotes inflammation throughout the body (Fiorentino et al., 2015).
  • Weaknesses in collagen that occur when blood sugar is chronically high. This means that bone in someone with diabetes (regardless of type) is more fragile than would be expected for a given bone density, putting them at greater fracture risk. One recent symposium of international scientists even called for recognition of “diabetic osteodystrophy” given how well-known the connection between diabetes and poor bone health has become (Epstein et al., 2016).

Diabetes dramatically increases fracture risk

Even though folks with diabetes often have higher bone densities then their non-diabetic peers, they fracture much more. A recent systemic review of 16 studies confirms that those with type 2 diabetes have nearly 3 times the risk of hip fracture as age-matched non-diabetics. Persons with type 1 diabetes fare even worse, having more than a 6-fold increased risk of hip fracture as they age.

3 steps to manage blood sugar and support bone health

Given these connections, it might not be surprising that many steps you can take to manage blood sugar are the same things we recommend to support bone health:

  1. Get regular exercise. Just as exercise stimulates osteoblasts to build bone, it also makes cells more receptive to insulin — particularly in skeletal muscle. Studies have shown that even short-duration exertion can improve blood glucose levels (Colberg et al., 2013). So every time you walk, hop, or do yoga for bone health, you’re also maintaining your insulin sensitivity and reducing blood sugar.
  2. Try the Alkaline for Life diet. People with diabetes are urged to eat a diet rich in vegetables, legumes, whole grains, nuts and seeds, and lean meats with very limited processed sugars — sound familiar? My Alkaline for Life diet and diabetes-friendly diets such as DASH or the Mediterranean diet (Ley et al., 2014) advocate these foods for good reason, as they reduce inflammation and support stable blood sugar levels, making them good for bones as well as diabetes.
  3. Test your vitamin D. We know that vitamin D is essential for bone health. No surprise, correlations between both types of diabetes and low vitamin D have also been found (Song et al., 2013; Raab et al., 2014), so have your vitamin D level tested and make sure you have a 50 to 60 ng/dL level all year round.

And should you be among the nearly 10% of our population that already has diabetes, or if you have been told you are “pre-diabetic,” now is the time to get serious about both controlling your blood sugar and implementing my comprehensive Better Bones Program.

So in honor of World Diabetes Day, I urge everyone to remember that taking care of your blood sugar is taking care of your bones — and vice versa!


Colberg, SR, Hernandez, MJ, and Shahzad, F. Blood Glucose Responses to Type, Intensity, Duration, and Timing of Exercise. Diabetes Care 2013 Oct; 36(10): e177-e177. http://dx.doi.org/10.2337/dc13-0965

Epstein S., Defeudis, G., Manfrini, S., Napoli, N., and Pozzilli, P on behalf of the Scientific Committee of the First International Symposium on Diabetes and Bone. (2016). Diabetes and disordered bone metabolism (diabetic osteodystrophy): time for recognition. Osteoporosis International 27: 1931–1951.

Fiorentino TV, Prioletta A, Zuo P, Folli F. Hyperglycemia-induced oxidative stress and its role in diabetes mellitus related cardiovascular diseases. Curr Pharm Des. 2013;19(32):5695-703.

Ivaska, K.K., Heliövaara, M.K., Ebeling, P., et al. The effects of acute hyperinsulinemia on bone metabolism. Endocr Connect 2015; 4(3): 155-162.

Janghorbani,M., et al. Systematic review of type 1 and type 2 diabetes mellitus and risk of fracture. Am J Epidemiol. 2007;166 (5):495–505.

Ley, S.H., Hamdy O., Mohan V., Hu F.B. Prevention and management of type 2 diabetes: dietary components and nutritional strategies. The Lancet 2014; 383(9933):1999–2007.

Raab, J., Giannopoulou, E.Z., Schneider, S. et al. Prevalence of vitamin D deficiency in pre-type 1 diabetes and its association with disease progression. Diabetologia (2014) 57: 902. doi:10.1007/s00125-014-3181-4

Rosen, C.J., Motyl, K.J. No bones about it: Insulin modulates skeletal remodeling. Cell 2010;142:198–200.

Song, Y., Wang, L., Pittas, A.G., Del Gobbo, L.C., Zhang, C., Manson, J.E., Hu, F.B. Blood 25-Hydroxy Vitamin D Levels and Incident Type 2 Diabetes. Diabetes Care 2013 May; 36(5): 1422-1428. http://dx.doi.org/10.2337/dc12-0962




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We created the Better Bones blog as our forum to express opinions and educate the public about natural means of supporting and improving bone health and overall wellness. As part of this forum, we sometimes discuss medical issues and medications, and their effects on bone health in general. However, we cannot advise readers about specific medical issues in this forum. If you wish to obtain advice from Susan E. Brown, PhD, about your specific bone health and nutritional concerns, please visit our Consultations page. Other specific medical questions should be referred to your healthcare provider.

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