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Two-year exercise training improves bone mineral density and trabecular bone score in type 2 diabetesTwo year exercise program improves bone health for seniors with diabetes

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Key Takeaway
Consider a two-year exercise program to improve BMD and muscle function in elderly patients with type 2 diabetes.

This randomized clinical trial enrolled 200 elderly individuals with type 2 diabetes who did not have osteoporosis. Participants were assigned to either a specifically-designed two-year exercise training program or standard care for a duration of two years.

Primary outcomes included trabecular bone score (TBS) and bone mineral density (BMD) at three sites. The Exercise group showed significant increases in lumbar spine BMD (95% CI [0.005-0.024], p = 0.004), femoral neck BMD (95% CI [0.006-0.028], p = 0.003), and total hip BMD (95% CI [0.010-0.030], p < 0.0001) compared to the Control group. TBS increased in the Exercise group while decreasing in the Control group, though this difference disappeared after adjusting for abdominal fat indices.

No between-group differences were reported regarding adverse events. A primary limitation of the study is that the observed improvements in TBS were associated with changes in abdominal fat indices. While the exercise program improved non-invasive measures of bone health and muscle function, the study did not provide data on fracture risk reduction.

How this fits prior evidence

How this fits prior evidence: This finding addresses a gap in management for elderly patients with type 2 diabetes by providing evidence that structured exercise improves bone mineral density. While other covered topics focus on pharmacological interventions like Canagliflozin for cardiovascular risk or surgical outcomes for MAFLD, this study highlights non-pharmacological improvements in bone health metrics.

Living with type 2 diabetes can sometimes come with concerns about bone health as you age. A new study looked at how a specific, two-year exercise training program could help older adults maintain stronger bones and better physical function.

The researchers followed 200 elderly participants who did not have osteoporosis. Those in the exercise group showed significant improvements in bone mineral density across three different sites, including the lumbar spine and hip. They also saw improvements in muscle strength and overall physical performance compared to those receiving standard care.

While the results were promising for bone health, researchers noted a specific detail regarding trabecular bone score. This measure of bone structure improved in the exercise group but only stayed significant when not adjusted for abdominal fat levels. The program was well tolerated, with no differences in side effects between the two groups.

What this means for you:
A two-year tailored exercise program improves bone density and muscle strength in older adults with type 2 diabetes.

Common questions

How did the exercise program affect bone density?

The study found that participants in the exercise group saw increases in bone mineral density at three sites, including the lumbar spine and femoral neck. These results were compared to a control group receiving standard care over a two-year period.

Is this exercise program safe for seniors with diabetes?

The study reported no differences in adverse events between the group that exercised and the group that received standard care. The training was used to improve bone health and muscle function in 200 elderly individuals.

What other physical benefits did the participants see?

In addition to better bone measures, those in the exercise program showed improvements in muscle strength, muscle quality, and cardiorespiratory fitness. These factors contribute to overall physical performance for people with type 2 diabetes.

Study Details

Study typeRct
Sample sizen = 1
EvidenceLevel 2
PublishedJul 2026
View Original Abstract ↓
AIMS: To assess the effects of exercise on non-invasive measures of bone health in elderly individuals with type 2 diabetes without osteoporosis. METHODS: In this randomized clinical trial, 200 elderly individuals with type 2 diabetes without osteoporosis were randomized 1:1 to a two-year, specifically-designed exercise training program (Exercise group) or standard care (Control group). Coprimary outcomes were trabecular bone score (TBS), a surrogate measure of bone quality, and bone mineral density (BMD) at three sites. Secondary outcomes were other bone measures and muscle and physical function parameters. RESULTS: The coprimary endpoints increased in the Exercise group and decreased in the Control group. Significant between-group differences were observed for TBS (mean, 0.016 [95% confidence interval, 0.011-0.021], p < 0.0001, which disappeared after adjusting for abdominal fat indices), and lumbar spine (0.014 [0.005-0.024], p = 0.004), femoral neck (0.017 [0.006-0.028], p = 0.003), and total hip (0.020 [0.010-0.030], p=<0.0001) BMD. Significant between-group differences were observed also for other bone measures, body composition, muscle strength and quality, physical performance, and cardiorespiratory fitness. There were no between-group differences in adverse events. CONCLUSIONS: A two-year exercise training improved several non-invasive measures of bone health, together with muscle and physical function parameters, potentially reducing fracture risk in people with type 2 diabetes.
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