A simple blood test could reveal your risk of diabetic eye and kidney disease before symptoms even begin.
Groundbreaking research reveals the "bone-vascular axis" connecting bone metabolism with microvascular complications in diabetes
Our bones are far from the static, chalk-like structures we might imagine. They're living, dynamic tissues constantly undergoing a process called remodeling—where old bone is broken down and new bone is formed.
Special cells called osteoclasts act as bone's demolition crew, clearing away old tissue. This process leaves behind chemical traces in our bloodstream—bone turnover markers (BTMs)—that provide a window into bone health activity.
The concept of a "bone-vascular axis" represents a paradigm shift in how we understand diabetes complications.
Hormones like osteocalcin influence both bone formation and metabolic processes, creating a direct communication pathway between bone and vascular systems.
Blood flow delivers nutrients to bone tissue while removing waste products. Disruption in microvascular circulation directly impacts bone health.
Chronic inflammation and oxidative stress affect both bone and vascular systems simultaneously, explaining their coordinated deterioration in diabetes.
When diabetes disrupts this delicate balance, both systems suffer—weakened bones coincide with damaged microvessels in eyes, kidneys, and nerves.
Recent clinical research has brought this connection into sharp focus with a 2025 study investigating the relationship between a specific bone marker and diabetic eye disease 1 .
Diabetic retinopathy patients showed significantly lower PINP levels than those without eye complications. When researchers divided participants into four groups based on PINP levels, a clear pattern emerged:
| PINP Quartile | PINP Range (ng/ml) | Risk Reduction for Diabetic Retinopathy |
|---|---|---|
| Q2 | 25.59-33.60 | 49.9% |
| Q3 | 33.61-43.05 | 71.1% |
| Q4 | >43.05 | 92.3% |
Even more impressive was the predictive power when PINP was combined with traditional risk factors. The area under the curve (AUC)—a measure of diagnostic accuracy where 1.0 represents perfect prediction—reached 0.827 for the combined model, indicating strong predictive value 1 .
The bone-vascular connection extends beyond retinopathy to diabetic kidney disease (DKD) 3 .
| Bone Turnover Marker | Type | Change in DKD Patients | Association with DKD Risk |
|---|---|---|---|
| β-CTX | Bone resorption marker | Significantly decreased | Strong independent association |
| N-MID | Bone formation marker | Significantly decreased | Not independently significant |
| PINP | Bone formation marker | Significantly decreased | Not independently significant |
The most significant finding was that lower β-CTX levels independently correlated with higher prevalence of DKD, even after adjusting for other factors 3 . This pattern was particularly pronounced in male patients and those under 60 years of age.
| Patient Group | 25-hydroxy-vitamin D | PTH | BGP (Osteocalcin) | β-CTX | T-PINP |
|---|---|---|---|---|---|
| Healthy Controls | 33.03 ± 5.83 | 23.08 ± 8.32 | - | - | - |
| Simple Diabetes | Lower than controls | Higher than controls | Lower than controls | Higher than controls | Lower than controls |
| DN with Microalbuminuria | Lower than simple diabetes | Higher than simple diabetes | Lower than simple diabetes | Higher than simple diabetes | Lower than simple diabetes |
| DN with Massive Proteinuria | Lowest levels | Highest levels | Lowest levels | Highest levels | Lowest levels |
Note: DN = Diabetic Nephropathy; Table based on data from 5 showing progressive changes across disease stages
What tools are scientists using to unravel the bone-vascular connection?
A sensitive formation marker measured via liquid chromatography-tandem mass spectrometry (LC-MS/MS) or electrochemiluminescence immunoassay 1 5
A bone resorption marker detected through electrochemiluminescence immunoassay, providing insight into bone breakdown activity 3 5
A stable portion of osteocalcin measured as a bone formation marker, with links to glucose metabolism 3
The primary circulating form of vitamin D, assessed using direct chemiluminescence, crucial for calcium homeostasis 5
Gold standard method for precise bone marker quantification, offering high specificity and sensitivity 1
Automated system (e.g., cobas e601) enabling high-throughput, precise measurement of multiple bone markers simultaneously 5
The clinical implications of this research are profound.
Bone turnover markers may signal complication risk before visible symptoms or traditional diagnostic signs appear, allowing for earlier intervention.
Simple blood tests could track progression and treatment response more effectively than current methods, reducing patient burden.
Bone marker profiles might help tailor individual treatment strategies based on complication risk, moving toward precision diabetes care.
While more research is needed to standardize measurements and establish definitive reference ranges, the foundation is being laid for a new approach to diabetes management—one that recognizes the interconnected nature of our biological systems.
The emerging science makes clear that bone health isn't just about preventing fractures—it's about preserving overall health and preventing devastating complications in people with diabetes. As research continues to unravel the complex dialogue between bone and blood vessels, we move closer to a future where diabetes complications can be predicted earlier and prevented more effectively.
The message is clear: when it comes to diabetes care, we can no longer afford to overlook what our bones are trying to tell us.