Bone fragility in type 1 diabetes: new insights and future steps

Bone fragility is a recognised complication of type 1 diabetes.1 People with type 1 diabetes have lower bone mineral density (BMD) and greater fracture risk than individuals without diabetes (more than five times for hip fracture and two times for non-vertebral fractures).2 The mechanisms underlying the lower BMD and greater fracture risk in this population include absence of insulin, long diabetes duration, poor glycaemic control, oxidative stress, and impaired Wnt signalling.3,4 People with long-term type 1 diabetes with a low risk of cardiovascular complications also have low rates of osteoporosis and fractures,5 suggesting that bone fragility is associated with vascular complications.