Femora from adults with type 1 or type 2 diabetes have lower bone strength and smaller hip geometry

Emerzian SR, Johannesdottir F, Lee DC, Wu IH, Teja Jangolla SV, Yu MG, Shah HS, King GL, Keaveny TM, Engelke K, Yu EW, Bouxsein ML (2026)

Publication Type: Journal article

Publication year: 2026

Journal

JBMR Plus Wiley

Book Volume: 10

Article Number: ziaf127

Journal Issue: 3

DOI: 10.1093/jbmrpl/ziaf127

Abstract

The increased hip fracture risk in individuals with type 1 (T1D) and type 2 (T2D) diabetes is not explained by areal BMD (aBMD), indicating that diabetes increases fracture risk through mechanisms independent of aBMD. To investigate, we used QCT to compare femoral strength, volumetric BMD (vBMD), and geometry in cadaveric femora from older adults with T1D (n = 23; 13 female) and T2D (n = 21; 11 female) to controls of similar age, sex, and race (n = 19; 11 female). While aBMD and vBMD measures were similar across groups, femoral strength was lower in the diabetic groups compared to controls. Geometric strength, based on external bone shape, was lower in T1D (−15%, p = .001) and T2D (−12%, p = .014) compared to controls. When combining geometry and density, femoral strength was significantly lower in T1D (−19%, p = .044). The strength-to-density ratio was also lower in T1D and T2D (p ≤ .013), indicating greater skeletal fragility in the diabetic groups beyond what is predicted by BMD. Diabetic groups had smaller bone size, including lower femoral neck volume (−8%, p ≤ .030), neck cross-sectional area (CSA) (−8%, p ≤ .030), and trochanter CSA (−7%, p ≤ .010). These findings suggest that lower femoral strength and smaller geometry contribute to elevated fracture risk in diabetes, warranting further study in larger populations.

Authors with CRIS profile

Klaus Engelke Lehrstuhl für Medizinische Physik und Mikrogewebetechnik (IMP)

Involved external institutions

Joslin Diabetes Center US United States (USA) (US) Beth Israel Deaconess Medical Center (BIDMC) US United States (USA) (US) O.N. Diagnostics, LLC US United States (USA) (US) Harvard University US United States (USA) (US)

How to cite

APA:

Emerzian, S.R., Johannesdottir, F., Lee, D.C., Wu, I.H., Teja Jangolla, S.V., Yu, M.G.,... Bouxsein, M.L. (2026). Femora from adults with type 1 or type 2 diabetes have lower bone strength and smaller hip geometry. JBMR Plus, 10(3). https://doi.org/10.1093/jbmrpl/ziaf127

MLA:

Emerzian, Shannon R., et al. "Femora from adults with type 1 or type 2 diabetes have lower bone strength and smaller hip geometry." JBMR Plus 10.3 (2026).

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