Diabetic patients are at increased risk of fracture osteoporosis, but its clinical significance has been debated. For this reason, Prof. GudrunLeidig-Bruckner and his team from the University of Heidelberg, Germany, conducted a study to investigate the prevalence of osteoporosis in patients with type 1 and type 2 diabetes and to analyze the determinants of bone mineral density (BMD) in diabetic patients. The results of the study were published in the April 2014 issue of BMCendocrine disorders. In the study, Professor Bruckner et al. recruited 398 consecutive patients with diabetes in a specialist outpatient clinic, and all subjects underwent a standard fracture osteoporosis risk factor questionnaire and were assessed for diabetes-related complications, HbA1c levels, and lumbar spine (LS) and femoral neck (FN) bone mineral density. Of all subjects included in the study, 139 patients with type 1 diabetes (71 men and 68 women) and 243 patients with type 2 diabetes (115 men and 128 women) were enrolled. BMD (T-values after correction for age, BMI and duration of diabetes) was compared between patients, and in addition, the study compared BMD between the type 2 diabetes group and population-based controls (255 males and 249 females). The study found no significant differences in corrected BMD between type 1 and type 2 diabetics for all genders, but increased BMD in type 2 diabetics compared to controls. the prevalence of osteoporosis (BMDT values <-2.5 SD) was similar between type 1 and type 2 diabetics, but the prevalence of osteoporosis was lower in type 2 diabetics than in controls. Also, Professor Bruckner found that the prevalence of osteoporosis by femoral neck BMD values was higher than the prevalence of fracture osteoporosis by lumbar spine BMD values in diabetic patients. BMD in diabetic patients was positively correlated with BMI and negatively correlated with age, but not significantly correlated with diabetes-specific parameters (treatment regimen, HbA1c, microvascular complications, macrovascular complications). The incidence of fragility fractures was lower in diabetic patients, about 5.2%, and, there was no significant difference in the incidence of fragility fractures between type 1 and type 2 diabetic patients. BMD was lower in patients with fractures compared to those without fractures, however, most patients with fractures had BMDT values >-2.5 SD. This study suggests that diabetes-specific parameters do not predict BMD. the incidence of fractures in patients with type 1 and type 2 diabetes is similar and both are associated with lower BMD, however, it does not seem to be related to the threshold of BMDT values <-2.5 SD. Professor Bruckner points out that osteoporosis and its associated fractures remain a clinically significant, but often underestimated, problem in diabetic patients.