Researchers used advanced 3D bone scans to compare hip bone strength between 74 people with type 2 diabetes and 51 healthy people. While regular bone density tests showed no differences, the detailed 3D scans revealed that people with diabetes had weaker bones in key areas of the hip, especially women. The study found that diabetes appears to affect the inner spongy bone and outer hard shell differently than what standard tests can detect. This suggests people with diabetes might need more specialized bone health monitoring, even if their regular bone scans look normal.

The Quick Take

  • What they studied: Whether people with type 2 diabetes have weaker hip bones than healthy people, using advanced 3D bone scanning technology
  • Who participated: 125 adults around age 54 - 74 with type 2 diabetes (mostly women) and 51 healthy people for comparison
  • Key finding: People with diabetes had weaker bones in important hip areas, but only the advanced 3D scans could detect this - regular bone tests missed it completely
  • What it means for you: If you have diabetes, regular bone density tests might not tell the whole story about your bone health, so discuss more detailed testing with your doctor

The Research Details

Researchers recruited people with type 2 diabetes and healthy volunteers, then used two different types of bone scans on everyone. First, they did standard bone density tests (called DXA scans) that most doctors use. Then they used special 3D software to analyze the same scans in much more detail, looking at different layers of bone separately. They focused on the hip area, measuring things like bone thickness, density, and volume in multiple spots. The team also collected information about participants’ weight, height, waist size, and vitamin D levels to see how these factors might affect bone health.

This approach is important because it compares the standard test doctors currently use with a more advanced analysis of the same scan. This helps us understand whether current bone testing methods are missing important problems in people with diabetes. The 3D analysis can separate the hard outer shell of bone from the spongy inner part, which may be affected differently by diabetes.

This study used well-established criteria to diagnose diabetes and included a good comparison group of healthy people. The sample size of 125 people provides reasonable reliability, though larger studies would be even better. The researchers used standard statistical methods and controlled for factors like age and gender that could affect the results.

What the Results Show

The most striking finding was that regular bone density tests showed no differences between people with diabetes and healthy controls - they looked exactly the same. However, when researchers used 3D analysis on the same scans, clear differences emerged. People with diabetes had consistently lower bone density in multiple areas of the hip, with the most significant problems in the trochanter (upper thigh bone) and femoral neck (hip joint area). The outer shell of bone (cortical thickness) was also thinner in people with diabetes. These differences were most pronounced in women with diabetes, who showed weaker bones in both the trochanter and femoral neck areas.

The study found that both groups had surprisingly high rates of vitamin D deficiency - 56% of healthy people and 64% of people with diabetes had levels below 20 ng/mL. Interestingly, people with higher body weight and larger waist measurements actually had stronger bones in all areas measured. The average person with diabetes in the study had been living with the condition for about 11 years.

This research supports previous studies suggesting that diabetes affects bone quality in ways that standard tests can’t detect. Earlier research has also linked long-term diabetes and poor blood sugar control to bone problems, particularly in women. This study adds important evidence that current bone testing methods may be inadequate for people with diabetes.

The study only looked at one point in time rather than following people over years to see how bone changes develop. The sample size, while reasonable, was relatively small for drawing broad conclusions. The researchers didn’t have detailed information about participants’ blood sugar control or diabetes medications, which could influence bone health. Also, the study only examined hip bones, so we don’t know if similar patterns occur in other areas like the spine or wrists.

The Bottom Line

If you have type 2 diabetes, especially if you’re a woman, consider discussing more detailed bone health assessment with your doctor beyond standard bone density tests. Maintain a healthy weight, as the study suggests this may help protect bone health. Ensure adequate vitamin D levels through testing and supplementation if needed. Focus on good diabetes management, as poor long-term blood sugar control appears linked to bone problems.

This research is most relevant for people with type 2 diabetes, particularly women and those who have had diabetes for many years. Healthcare providers treating diabetes patients should also pay attention to these findings. People with normal bone density test results but diabetes shouldn’t assume their bones are completely healthy.

Bone changes from diabetes likely develop slowly over years. The people in this study had diabetes for an average of 11 years before differences were detected. Regular monitoring and preventive measures should be ongoing rather than waiting for problems to appear.

Want to Apply This Research?

  • Track your bone density test results over time and note whether your doctor uses standard or advanced 3D analysis methods
  • Log weight-bearing exercises, vitamin D supplementation, and diabetes management metrics like blood sugar levels, as these may all impact bone health
  • Set annual reminders to discuss bone health with your healthcare provider, especially if you’re a woman with diabetes, and track any changes in mobility or joint pain

This information is for educational purposes only and should not replace professional medical advice. If you have diabetes or concerns about bone health, consult with your healthcare provider about appropriate testing and treatment options specific to your situation.