By Amber Jackson, RN, DCES
We know type 1 diabetes (T1D) can affect bone health—but new research suggests kidney health may be an important part of that story.
A large study published in Diabetes Care followed more than 5,000 people with T1D for a median of nearly 33 years and compared them with more than 12,000 people without diabetes.
The differences were striking. Compared with people without diabetes, those with T1D had approximately:
- 2.2× the risk of any fracture
- 2.6× the risk of a major osteoporotic fracture
- 5.2× the risk of hip fracture
And this wasn’t just a problem of older age. Excess fracture risk was already apparent between ages 10–19.
The Kidney Connection
The particularly interesting finding was what happened as diabetic kidney disease (DKD) progressed.
Fracture risk increased step-by-step with worsening kidney disease. Even people with T1D and normal urinary albumin excretion had elevated fracture risk. But among those who progressed to kidney failure, overall fracture risk was about 5 times that of people without diabetes.
The most dramatic finding?
People with T1D and kidney failure had an 18.6-fold higher incidence of hip fracture.
Poorer glycemic control and a greater number of severe hypoglycemic episodes were also associated with fracture risk, while more episodes of DKA were associated with major osteoporotic fractures.
Protect the Kidneys—and the Bones
Bone health deserves attention throughout life with T1D, but these findings suggest it may deserve even greater attention when kidney disease enters the picture.
A few basics can help support strong bones:
- Use them. Regular weight-bearing activity and resistance training provide the mechanical stimulus bones need to maintain strength.
- Feed them. Adequate calcium, vitamin D, protein and overall energy intake are important for building and maintaining bone.
- Protect kidney and glucose health. Regular kidney screening, minimizing prolonged hyperglycemia when possible, and reducing severe hypoglycemia and DKA may have benefits that extend well beyond glucose numbers.
If you’ve had T1D for many years, have kidney disease, or have other fracture risk factors, talk with your healthcare provider about whether earlier bone mineral density (BMD) screening is appropriate.
The researchers noted that fracture risk in T1D may reach recommended thresholds for BMD screening earlier than traditionally expected.
Resources
Feodoroff M, et al. Fracture Risk Is Increased in Type 1 Diabetes and Further Aggravated by Diabetic Kidney Disease. Diabetes Care. Published online July 27, 2026. doi:10.2337/dc26-0612.
