Type 2 diabetes mellitus (T2DM) is associated with elevated risks of osteoporosis and fractures, but the contribution of diabetic microvascular complications remains poorly defined—especially in Asian populations. Prior studies have suggested links between diabetes-related complications and skeletal fragility, but most were limited by small sample sizes, cross-sectional designs, or inadequate adjustment for key confounders such as medication use, fall history, and comorbidities. Using Taiwan’s National Health Insurance Research Database, we conducted a large-scale, population-based cohort study of individuals newly diagnosed with T2DM (2008–2020) to assess associations between microvascular complications and the risk of new-onset osteoporosis and osteoporotic fractures using multivariable Cox proportional hazards models. In this East Asian cohort, patients with diabetic neuropathy (DN), retinopathy (DR), or kidney disease (DKD) exhibited a graded increase in the risk of both osteoporosis and major osteoporotic fractures, including those of the hip, spine, humerus, and radius/ulna. Compared to patients without microvascular disease, those with DR and DN had significantly higher risks of osteoporosis (adjusted hazard ratio aHR: 1.14 95% CI: 1.09–1.19 and 1.25 1.22–1.28, respectively; p < 0.001). Furthermore, amongst the microvascular complications, DN showed the strongest and most consistent associations with osteoporosis and spine fractures. This nationwide cohort focused exclusively on newly diagnosed T2DM patients and comprehensively adjusted for confounders. Our findings suggest that microvascular complications may serve as independent predictors of skeletal fragility and support their incorporation into fracture risk assessment models, particularly for Asian individuals with T2DM.
Yen et al. (2026) studied this question.