Both osteoporosis and the diabetic foot pose significant social problems. Both conditions lead to serious complications in their later stages and both need early diagnosis which makes treatment much more effective, reduces the socio-economic impact and outcomes improved. Together with other possible factors such as genetic factors, calcium intake and levels of physical activity, diabetes itself could play an additional role in the diminution of bone mineral density (Gregorio et al, 1994; Kayath et al, 1994). Of practical significance is the high frequency of osteoporosis among young people with diabetes where osteoporosis, because of advanced age, is excluded.

Type 1 diabetes has long been associated with low bone density (Strotmeyer et al, 2006). However, it was unclear until recently whether this translated into increased fracture rates. Results from the Nord-Trondelag Health Survey from Norway showed a significant increase in hip fracture rates among female participants with type 1 diabetes (relative risk 6.9, confidence interval 2.2–21.6) compared to females without diabetes (Forsen et al, 1999).
    The mechanism of bone loss in type 1 diabetes is still unknown, although several theories exist based on animal and cellular models. Insulin-like growth factors and other cytokines may influence metabolism in the bones of people with diabetes (Bouillon, 1991). Diabetic retinopathy, advanced cortical cataracts and diabetic neuropathy have all been associated with increased fractures (Ivers et al, 2001; Piepkorn et al, 1997). These are also risk factors for increased falls due to visual impairment and alterations in balance and gait. For people with type 1 diabetes, the initial onset of the disease often occurs at a young age when bone mass is still being accrued. Thus, low bone mass would seem a likely complication of type 1 diabetes in adulthood.
    Type 2 diabetes was previously believed to provide protection against osteoporosis because of its association with normal-to-increased bone mineral density (BMD; Isaia et al, 1999). This theory was primarily based on the concept of BMD alone and predominantly not from prospective controlled large trials. When considering all risk factors, people with diabetes generally have an increased risk of falling because of peripheral neuropathy, possible hypoglycaemia, nocturia and visual impairment.