A new danger of diabetes has been identified

Diabetes increases the risk of fractures even with normal bone density - this is the conclusion reached by international experts in a large review published in Osteoporosis International. The situation looks especially unusual in type 2 diabetes: despite increased bone mineral density (BMD), such patients experience fractures more frequently.

Research shows: the key to the paradox is in the change of bone microstructure. Patients with type 2 diabetes have more trabecular tissue, but also higher porosity of the cortical layer - the main support of the bone. These microchanges become especially pronounced in the late stages of the disease.

To clarify risk assessment, the TBS indicator - trabecular bone score, calculated from spine images - is used. In people with diabetes, it is often reduced, indicating bone "fragility." However, in patients with obesity, this value may be distorted: adipose tissue interferes with accurate measurement, which requires revision of the calculation algorithm.

The authors call for revising the approach to diagnosing osteoporosis in diabetics, including updated TBS algorithms and the use of comprehensive assessments.