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Type 2 Diabetes and Bone Health

Bone Health

Did you know that if you have type 2 diabetes you may be at greater risk for fractures?

Researchers Khazai, Beck, and Umpierrez reported that in comparison to the general population, individuals with type 2 diabetes have an increased risk of hip fractures, while those treated with an oral anti-diabetic agent or insulin have a greater risk of wrist and foot fractures.

Osteoporosis, a common condition impacting approximately 54 million Americans, is characterized by a loss of bone density, making bones more prone to fracture. Individuals who are either overweight or obese (a common feature seen in type 2 diabetes) tend to have a greater bone mineral density (BMD).

So why the increase in fractures?

According to Khazai, Beck, and Umpierrez: the increased amount of fractures seen in type 2 diabetes is due to “impaired bone quality rather than impaired bone density.”

Long-term poorly controlled diabetes results in an “increased glycation of bone and protein cells.” Glycation is the process where sugar in the blood stream attaches to proteins, which in turn forms new harmful molecules called advanced glycation end products (AGEs). These AGEs may negatively impact collagen and osteocytes.

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  • Collagen is a protein that helps hold the whole body together. It is found in muscles, skin, and tendons. It forms the framework to provide strength and structure to the body.
  • Osteocytes are bone-forming cells.

Additional factors that may increase fracture and/or osteoporosis risk include:

  • Peripheral and autonomic neuropathy (due to increased fall risk)
  • Recurrent hypoglycemic events (increased fall risk with severe hypoglycemia)
  • Vitamin D deficiency
  • Thiazolidinedione therapy (Actos and Avandia)
  • Diet low in calcium and vitamin D
  • Not exercising
  • Tobacco use
  • Consuming more than 2 alcoholic beverages per day
  • There are several health problems, medications, and medical conditions that may put a person at increased risk for developing osteoporosis (A more complete list can be provided by your health care provider).

Of the above mentioned risks, increasing your dietary calcium and vitamin D intake may help reduce fracture risk. Milk, yogurt and cheese are some of the richest sources of calcium. However, if you have diabetes, you may find yourself avoiding (or significantly limiting) milk and yogurt, as both foods contain carbohydrate in the form of lactose (“milk sugar”).

Other natural sources of calcium:

  • Kale
  • Spinach
  • Chinese cabbage
  • Canned pink salmon (solids with bones)

The most natural way to get vitamin D is by exposing bare skin to sunlight. However, many people avoid sunlight or use sunscreen to block ultraviolet B rays (UVB) in an effort to reduce potential skin damage. As a result, vitamin D needs must come from the diet or from supplements. Vitamin D does not occur naturally (in large quantities) in many foods. As such, many people get their vitamin D needs from foods supplemented with Vitamin D such as milk and yogurt (again….if you have diabetes, these may be foods your choose to avoid/limit due to their carbohydrate content).

  • Recommended Dietary Allowance for Calcium (19 to 70 years old, not pregnant or lactating): 1000 mg per day
  • Recommended Dietary Allowance for Vitamin D: (19 to 70 years old): 600 IU per day

Check out the following smoothie recipe, featuring almond milk, for an extra boost of calcium and vitamin D.

One serving (1 cup) of almond milk provides 45 percent (450 mg) of the recommended dietary allowance for calcium and 25 percent of the recommended dietary allowance for vitamin D (150 IU).

Almond milk smoothie


  • 1 cup unsweetened Almond Milk (A few brands to consider: Blue Diamond Almond Breeze, Silk, Pure Almond)
  • 2 tablespoons Powdered Peanut Butter (PB2: Powdered Peanut Butter by Bell Plantation)
  • ½ cup crushed ice
  • ½ very small banana (very small= 5 inches)


  • Combine all ingredient in blender
  • Pulse until well combined


  • Calories: 112
  • Carb: 15 grams
  • Fiber: 4 grams
  • Protein: 6.5 grams
  • Fat: 4 grams
This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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