Calcified Tissue International

, Volume 100, Issue 2, pp 122–132 | Cite as

Pathophysiology of Bone Fragility in Patients with Diabetes

  • Andrea Palermo
  • Luca D’Onofrio
  • Raffaella Buzzetti
  • Silvia Manfrini
  • Nicola Napoli


It has been well established that bone fragility is one of the chronic complications of diabetes mellitus, and both type 1 and type 2 diabetes are risk factors for fragility fractures. Diabetes may negatively affect bone health by unbalancing several pathways: bone formation, bone resorption, collagen formation, inflammatory cytokine, muscular and incretin system, bone marrow adiposity and calcium metabolism. The purpose of this narrative review is to explore the current understanding of pathophysiological pathways underlying bone fragility in diabetics. In particular, the review will focus on the peculiar cellular and molecular system impairment that may lead to increased risk of fracture in type 1 and type 2 diabetes.


Osteoporosis Diabetes Osteoblast Osteoclast Hyperglycaemia 



The authors thank Anda Naciu, MD, for the valuable support given to the drafting of this work.

Compliance with Ethical Standards

Conflict of interest

Andrea Palermo, Luca D’Onofrio, Raffaella Buzzetti, Silvia Manfrini and Nicola Napoli declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This is a systematic review and we did not perform any animal or human experiments for this work. For this type of study formal consent is not required.


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Copyright information

© Springer Science+Business Media New York 2017

Authors and Affiliations

  • Andrea Palermo
    • 1
  • Luca D’Onofrio
    • 2
  • Raffaella Buzzetti
    • 2
  • Silvia Manfrini
    • 1
  • Nicola Napoli
    • 1
    • 3
  1. 1.Diabetes and Bone network, Department Endocrinology and DiabetesUniversity Campus Bio-Medico of RomeRomeItaly
  2. 2.Department of Experimental Medicine, Polo PontinoSapienza University of RomeRomeItaly
  3. 3.Division of Bone and Mineral DiseasesWashington University in St LouisSt LouisUSA

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