Abstract
Diabetes mellitus is associated with an increased risk of osteoporosis and fractures due to impaired bone metabolism and increased fall risk. This case report highlights a 49-year-old Palestinian man with long-standing poorly controlled type 2 diabetes who presented with progressive back pain following a hypoglycemic syncopal episode. Clinical assessment and imaging, including magnetic resonance imaging (MRI) and Dual-Energy X-ray Absorptiometry (DEXA), confirmed a vertebral compression fracture at D12-L1 and severe osteoporosis. Laboratory investigations ruled out secondary causes of osteoporosis. The patient was treated with zoledronic acid, pain management, and improved glycemic control, leading to symptom relief and better metabolic outcomes after 6 months. This case underscores the importance of early osteoporosis screening in diabetic patients and highlights the need for an integrated approach to managing both diabetes and bone health to prevent fractures in high-risk individuals.