Abstract
The prevalence of type 2 diabetes (T2D) is rapidly growing due to increased obesity resulting from changing lifestyles. Thus, T2D has become a major health concern worldwide. Furthermore, the risk of osteoporotic bone fractures is increased in diabetic patients, and bone fragility has been recently recognized as a major diabetic complication. Because the fracture risk is independent of any change in bone mineral density, it is likely that the deterioration of bone tissue quality is one key cause of bone fragility. Bone metabolism is influenced by several diabetes-associated factors such as hyperglycemia, hyperinsulinemia, and formation of advanced glycation end products that impair the function of bone cells and results in deteriorated bone quality. Together, these factors provide a plausible explanation for the elevated fracture risk in T2D patients. This chapter provides a review highlighting the importance of bone quality, function of bone cells, bone remodeling process, and how cell behavior is affected in a T2D environment.