Effects of Diabetes on Bone Material Properties

  • Sashank Lekkala
  • Erik A. Taylor
  • Heather B. Hunt
  • Eve DonnellyEmail author
Bone and Diabetes (A Schwartz and P Vestergaard, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Bone and Diabetes


Purpose of Review

Individuals with type 1 and type 2 diabetes mellitus (T1DM, T2DM) have an increased risk of bone fracture compared to non-diabetic controls that is not explained by differences in BMD, BMI, or falls. Thus, bone tissue fracture resistance may be reduced in individuals with DM. The purpose of this review is to summarize work that analyzes the effects of T1DM and T2DM on bone tissue compositional and mechanical properties.

Recent Findings

Studies of clinical T2DM specimens revealed increased mineralization and advanced glycation endproduct (AGE) concentrations and significant relationships between mechanical performance and composition of cancellous bone. Specifically, in femoral cancellous tissue, compressive stiffness and strength increased with mineral content; and post-yield properties decreased with AGE concentration. In addition, cortical resistance to in vivo indentation (bone material strength index) was lower in patients with T2DM vs. age-matched non-diabetic controls, and this resistance decreased with worsening glycemic control. Recent studies on patients with T1DM and history of a prior fragility fracture found greater mineral content and concentrations of AGEs in iliac trabecular bone and correspondingly stiffer, harder bone at the nanosacle.


Recent observational data showed greater AGE and mineral content in surgically retrieved bone from patients with T2DM vs. non-DM controls, consistent with reduced bone remodeling. Limited data on human T1DM bone tissue also showed higher mineral and AGE content in patients with prior fragility fractures compared to non-DM and non-fracture controls.


Bone material properties Type 1 diabetes mellitus (T1DM) Type 2 diabetes mellitus (T2DM) Advanced glycation end products (AGEs) Diabetic murine models In vitro glycation 


Funding Information

Funding for this work was provided in part by NIH K01 AR064314 to ED.

Compliance with Ethical Standards

Conflict of Interest

Sashank Lekkala, Erik A. Taylor, Heather B. Hunt, and Eve Donnelly declare no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human participants or animals performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Sashank Lekkala
    • 1
  • Erik A. Taylor
    • 2
  • Heather B. Hunt
    • 1
  • Eve Donnelly
    • 1
    • 3
    Email author
  1. 1.Department of Materials Science and EngineeringCornell UniversityIthacaUSA
  2. 2.Sibley School of Mechanical and Aerospace EngineeringCornell UniversityIthacaUSA
  3. 3.Research DivisionHospital for Special SurgeryNew YorkUSA

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