Bone Abstracts

Background: Diabetes Mellitus is associated with increased fracture risk and impaired bone quality, even in individuals with normal bone mineral density. However, the relationship between diabetes and Osteoporosis remains under-recognized in low- and middle-income countries (LMICs), where healthcare systems are often fragmented. Nurses, as frontline providers, have the potential to address this gap, yet their preparedness for integrated non-communicable diseases (NCDs) management is unclear.

Methods: A national cross-sectional survey was conducted among 1,208 graduate nurses across 62 cities in Pakistan (MayAugust 2025). Standardized instruments assessed knowledge, attitudes, and readiness for advanced roles in diabetes care. Although osteoporosis-specific variables were not directly measured, findings related to complication management, training exposure, and clinical confidence were analyzed to explore implications for bone health integration.

Results: Findings demonstrated significant gaps in preparedness for comprehensive diabetes care among participants. A majority (64%) reported no formal or structured diabetes-specific training, while 72% lacked confidence in managing diabetes-related complications. Furthermore, 81% identified deficiencies in undergraduate curricula related to diabetes education. Only 34% expressed confidence in their clinical competencies for diabetes management, despite a high level of motivation, with over 80% indicating willingness to pursue advanced or specialized training. These results highlight critical deficiencies in workforce readiness for effective complication management, implying that associated riskssuch as bone health deterioration and fracture susceptibilitymay remain insufficiently recognized and inadequately addressed in routine clinical practice.

Conclusion: This study highlights a critical missed opportunity to integrate bone health into diabetes care in LMIC settings. Strengthening nursing education and introducing advanced practice roles could enhance early identification and prevention of osteoporosis-related complications. Nurse-led, integrated care models offer a scalable strategy to address the dual burden of diabetes and bone disease in resource-constrained health systems.