In addition to causing blood sugar imbalances, type 1 diabetes can contribute to nerve damage and sensory abnormalities–a condition call neuropathy–and has been linked to a higher risk of bone fractures. A new study published in the Journal of Bone and Mineral Research has examined the effects of type 1 diabetes and diabetic neuropathy on the skeleton.

Investigators found that type 1 diabetes and diabetic neuropathy have various impacts on bone structure, but these effects do not fully explain the higher fracture risk in patients with type 1 diabetes.

The results suggest that the increase in the risk of fractures in type 1 diabetes is multifactorial, with both skeletal and non-skeletal features involved.

“It is important to investigate what leads to an increased risk of fractures in type 1 diabetes. Our results suggest that in addition to bone features, balance and muscle strength also play a role,” said lead author Tatiane Vilaca, MD, PhD, of the University of Sheffield, in the U.K. “These findings could help improve approaches to fracture prevention.”