# Clinical features of osteoporosis in patients with type 1 and type 2 diabetes in Türkiye: A nationwide study

## TL;DR

This study found that osteoporosis is more common in women and older adults with type 2 diabetes in Türkiye, and many patients with osteoporosis are not receiving treatment.

## Contribution

The study provides the first nationwide assessment of osteoporosis prevalence and clinical features in diabetes patients in Türkiye.

## Key findings

- Osteoporosis prevalence was 9.36% in type 1 diabetes and 19.13% in type 2 diabetes.
- Fractures were sixfold higher in type 1 diabetes and fourfold higher in type 2 diabetes patients with osteoporosis.
- Only 13.4% of osteoporosis patients received pharmacological treatment.

## Abstract

This nationwide study assessed clinical features of osteoporosis in Turkish adults with diabetes. Osteoporosis prevalence was 9.36% in type 1 diabetes and 19.13% in type 2 diabetes, with higher rates in women and older individuals. Although overall fracture prevalence was low, fractures were markedly more frequent in patients with osteoporosis. Despite the high burden, most patients did not receive osteoporosis therapy, and age, female sex, and vascular complications were independently associated with osteoporosis.

Fragility fractures related to diabetes are increasing worldwide with rising life expectancy. We aimed to investigate the prevalence of osteoporosis and its associated factors in a large nationwide cohort of adults with type 1 (T1DM) and type 2 diabetes (T2DM) in Türkiye.

Using Turkish Ministry of Health electronic health records (2015–2021), adults with T1DM and T2DM were identified and classified according to the presence or absence of osteoporosis. Demographics, comorbidities, diabetes-related complications, fracture diagnoses, and laboratory parameters were analyzed. Factors independently associated with osteoporosis were evaluated using multivariable logistic regression.

The cohort included 76,742 individuals with T1DM (mean age 44.3 ± 19.1 years; 45.8% women) and 7,006,910 with T2DM (mean age 59.1 ± 13.4 years; 60.2% women). Overall osteoporosis prevalence was 19.03% and was 9.3% in T1DM and 19.1% in T2DM. Osteoporosis was more frequent in women than men (T1DM: 14.17% vs 5.29% p < 0.001; T2DM: 27.76% vs 6.04% p < 0.001) and increased with age in both diabetes types. Fractures occurred in 0.22% of patients with T1DM and 0.21% of those with T2DM. In T1DM, fracture frequency was approximately sixfold higher in patients with osteoporosis than in those without osteoporosis (RR ≈ 6.92; 95% CI 5.09–9.39; p < 0.001), whereas in T2DM osteoporosis was associated with an approximately fourfold higher fracture frequency (RR ≈ 3.98). Macrovascular and microvascular complications were more frequent among osteoporosis patients with T1DM than those with T2DM. Only 13.4% of patients with osteoporosis received pharmacological osteoporosis therapy. In multivariable analysis, older age (OR 1.06), female sex (OR 6.58), cardiovascular disease (OR 1.58), and microvascular complications (OR 1.38) were independently associated with osteoporosis.

In this nationwide Turkish cohort, osteoporosis affected 9.36% of adults with T1DM and 19.13% of those with T2DM. Among patients with osteoporosis, vascular complications were more prevalent in T1DM than in T2DM.Despite the substantial disease burden and the markedly higher fracture frequency in individuals with osteoporosis, most patients remained untreated.

The online version contains supplementary material available at 10.1007/s11657-026-01677-x.