Osteoporosis and vertebral fracture are associated with deterioration of activities of daily living and quality of life in patients with type 2 diabetes mellitus


Patients with type 2 diabetes mellitus (T2DM) have an increased risk of fragility fracture. However, whether diabetes-related osteoporosis independently contributes to the deterioration of activities of daily living (ADLs) and quality of life (QOL) is unclear. This cross-sectional study investigated the association between osteoporosis, ADLs, and QOL in 309 patients with T2DM. ADLs and QOL were assessed using Barthel Index (BI) and a SF-36 questionnaire. Multiple logistic regression analyses adjusted for age, gender, T2DM duration, body mass index, hemoglobin A1c, estimated GFR, diabetic neuropathy, retinopathy, nephropathy, cardiovascular disease, cerebrovascular disease, peripheral artery disease, and anti-diabetic treatments were conducted. The number of patients with osteoporosis or vertebral fracture was 166 (53.7%) and 118 (38.2%), respectively. Osteoporosis was significantly associated with lower general health (GH), social functioning (SF), and role emotional (RE) (OR 2.56, 1.79, and 1.92, respectively; all p values < 0.05 at least) and marginally associated with lower BI (OR 2.39, p = 0.068). Moreover, the presence of vertebral fracture grade 2 or 3 was significantly associated with lower BI, bodily pain (BP), GH, vitality, SF, and RE (OR 2.58, 2.01, 3.64, 1.99, 2.18, and 1.97, respectively; all p values < 0.05 at least). Osteoporosis and severe vertebral fracture were associated with the deterioration of ADLs and QOL independently of other diabetic complications. Therefore, the management of diabetes-related osteoporosis is an important strategy to avoid the deterioration of ADLs and QOL in T2DM.

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Activities of daily living


Barthel Index


Bone mineral density


Body mass index


Bodily pain


Estimated glomerular filtration rate


General health


Hemoglobin A1c


Mental health


Peripheral arery disease


Physical functioning


Role emotional


Role physical


Social functioning


Quality of life


Type 2 diabetes mellitus




Young adult mean


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The authors are grateful to the patients and hospital staff who participated in this study. This study was funded by the Japan Osteoporosis Foundation and partly supported by research Grant from Eli Lilly Japan. I.K. is fully responsible for the content of the manuscript.


This study was funded by the Japan Osteoporosis Foundation.

Author information




IK collected and analysed the data and prepared the manuscript. AT, KT, and YY collected the data. TS contributed to the discussion and reviewed the manuscript. All authors participated in the preparation of the manuscript and approved its final version for publication.

Corresponding author

Correspondence to Ippei Kanazawa.

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Conflict of interest

Ippei Kanazawa, Ayumu Takeno, Ken-ichiro Tanaka, Yuko Yamane and Toshitsugu Sugimoto declare that they have no conflicts of interest.

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Kanazawa, I., Takeno, A., Tanaka, Ki. et al. Osteoporosis and vertebral fracture are associated with deterioration of activities of daily living and quality of life in patients with type 2 diabetes mellitus. J Bone Miner Metab 37, 503–511 (2019). https://doi.org/10.1007/s00774-018-0948-6

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  • Type 2 diabetes mellitus
  • Osteoporosis
  • Vertebral fracture
  • ADLs
  • QOL