Neuropathy and Low Muscle Mass Linked to Falls in Diabetes

DIABETIC peripheral neuropathy combined with low muscle mass is associated with higher odds of osteoporosis, falls and fractures in people with Type 2 diabetes, a new study suggests.

The research also identified higher rates of osteoporosis and falls during follow-up among patients with both conditions. However, the longitudinal analysis did not show a statistically significant association with fractures, highlighting an important distinction between the study’s findings.

Examining Nerve and Muscle Health

Researchers investigated whether diabetic peripheral neuropathy and low appendicular muscle mass together identify patients with greater skeletal vulnerability. Appendicular muscle mass refers to the skeletal muscle in the arms and legs.

The study combined an exploratory analysis of the Survey of Health, Ageing and Retirement in Europe with a hospital-based cohort of patients with Type 2 diabetes in China. The European analysis examined diabetes, grip strength and skeletal outcomes, while the hospital cohort assessed clinically diagnosed neuropathy and muscle mass measured using dual-energy X-ray absorptiometry.

This distinction matters because low muscle mass alone does not establish sarcopenia, which also requires consideration of muscle strength or physical performance.

Stronger Associations With Falls

In the hospital cohort, patients with both neuropathy and low appendicular muscle mass had higher odds of osteoporosis, falls and fractures. The reported odds ratios were 2.15 for osteoporosis, 4.67 for falls and 2.42 for fractures.

During follow-up, the combined conditions were associated with higher hazards of osteoporosis and falls. The fracture association was not statistically significant.

These results should therefore be interpreted separately: higher odds of having experienced a fracture do not necessarily mean that a higher rate of subsequent fractures was demonstrated. The distinction is particularly relevant when translating observational findings into messages about future risk.

Implications for Clinical Assessment

The findings suggest that assessing nerve function alongside muscle health could help clinicians recognise patients who may warrant closer attention to mobility and bone health.

However, the study does not establish that either condition directly causes the outcomes, or that treating low muscle mass will prevent falls or fractures. Observational associations can also reflect other differences between patient groups.

For clinical practice, the research supports considering skeletal health as part of a broader assessment of diabetes complications. Further studies should establish whether combined assessment improves risk prediction and whether targeted interventions translate into fewer falls and fractures.

Reference

Zheng B et al. Diabetic peripheral neuropathy with low appendicular muscle mass is associated with osteoporosis, falls, and fractures. J Diabetes. 2026;18(11):e70276. doi:10.1111/1753-0407.70276.