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Diabetes mellitus negatively affects the skeleton and increases the fracture risk in both, type 1 (T1DM) and type 2 (T2DM) diabetes. Bone mineral density (BMD) is decreased in T1DM and increased in T2DM. The association between BMD and fracture risk is less strong in diabetes compared with other types of osteoporosis. There are structural changes of bone architecture that can be analyzed with advanced new technologies. The increased fracture risk is attributed to specific changes in bone metabolism. Among them are the leak of anabolic function of insulin on bone formation in T1DM and impairments of bone cell function by hyperglycemia. Bone structure and bone strength is impaired by increased formation of advanced glycation endproducts (AGEs). The risk assessment for osteoporotic fractures is performed on the basis of bone mineral density measurements but must individually include other independent risk factors. The quality of glycemic control is critical for most of diabetes related disturbances of bone integrity. © 2015 Dustri-Verlag.

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