Patients with type 2 diabetes display a unique skeletal phenotype with either normal or more frequently increased, bone mineral density and impaired structural and geometric properties. Recently, alterations in bone material properties seem to be the predominant defect leading to increased bone fragility. Accumulation of advanced glycation end-products and changes in collagen cross-linking along with suppression of bone turnover seem to be significant factors impairing bone strength. FRAX score has been reported to underestimate fracture risk and lumbar spine BMD is inadequate in predicting vertebral fractures.
https://www.ncbi.nlm.nih.gov/pubmed/25284729
Metabolism. 2014 Dec;63(12):1480-90. doi: 10.1016/j.metabol.2014.09.002. Epub 2014 Sep 28.