The various causes mentioned in this alteration of the quantity and bone quality in the context of chronic hyperglycemia is a disturbance of the interaction between osteoblasts (cells forming bone) and osteoclasts (cells that resorb bone), partly mediated by the system RANK / RANK-L / osteoprotegerin with decreased bone formation and increased osteolyses. The peripherical neuropathy, the glycation proteins (modifications of proteins by addition of glucose) and the receptor of glycation proteins are directly involved.