Critical appraisal of interaction between diabetes and osteoporosis: imbalance between inflammation and bone remodeling.

Zhang et al. provide a valuable review of inflammatory pathways in diabetes-related osteoporosis, but their focus risks oversimplifying a multifactorial disorder. Beyond cytokine-mediated bone remodeling, advanced glycation end products, microangiopathy, and neuropathy critically impair skeletal integrity. Large-scale epidemiological studies demonstrate significantly increased fracture risk in both type 1 and type 2 diabetes, underscoring the clinical burden. Yet, therapeutic evidence in diabetic cohorts remains limited, particularly in low-resource settings. Emerging tools-high-resolution imaging, biomarkers, and AI-driven prediction-offer promise for precision care. A comprehensive, interdisciplinary framework is essential to address the biological, clinical, and policy dimensions of diabetic osteoporosis.