Bone health in diabetes mellitus

Bone health depends on a complex interplay between cellular and extracellular components that together preserve skeletal integrity, microarchitecture, and mechanical strength. Disturbance of this balance in a range of pathophysiological states, particularly in diseases such as diabetes mellitus, may substantially impair bone quality, delay fracture healing, and increase fracture risk. This review summarizes the main mechanisms linking diabetes and bone health, with emphasis on advanced glycation, oxidative stress, chronic inflammation, hormonal and osteoimmune dysregulation, microvascular impairment, and altered mesenchymal stem cell fate. We also review bone turnover markers, the skeletal effects of contemporary glucose-lowering therapies, and emerging methodological approaches, including single-cell and spatial transcriptomic analyses. A more integrated understanding of these processes may improve risk stratification, treatment decisions, and prevention of skeletal complications in diabetes.