How Osteoporosis and Diabetes are Linked

Contributed by Abid Yaqub, MD

Osteo186331507-300x185Osteoporosis is a major public health problem because of its associated risk of fractures. Patients face greater risks of having a permanent disability and often require long-term nursing home care.Although osteoporosis traditionally has not been listed as a complication of diabetes, patients with either type 1 or type 2 diabetes are among those at increased risk for this disease.

Diabetes

In people with diabetes, the body produces either no insulin or in insufficient amounts which results in high glucose levels in the body leading to increased morbidity and mortality..

More than 25 million Americans have diabetes. Of these, approximately 5 to 10 percent have type 1 diabetes and 90 to 95 percent have type 2 diabetes.

Type 1 diabetes typically appears in children and young adults, but it can develop at any age. It has been linked to low bone density, although researchers don’t know exactly why. People with type 1 diabetes do not produce insulin, which may be needed for bone growth and strength. The onset of type 1 diabetes typically occurs at a young age when bone mass is still increasing. It is possible that people with type 1 diabetes achieve lower peak bone mass, the maximum strength and density that bones reach.  Low peak bone mass increases risk of developing osteoporosis later in life. Some people with type 1 diabetes also have celiac disease, which is associated with reduced bone mass. It is also possible that cytokines, substances produced by various cells in the body, play a role in the development of both type 1 diabetes and osteoporosis.

Recent research also suggests that women with type 1 diabetes may have an increased fracture risk, since vision problems and nerve damage associated with the disease have been linked to an increased risk of falls and related fractures. Hypoglycemia, or low blood sugar reactions, may also contribute to falls.

In type 2 diabetes, the body produces insulin but not enough, and the body does not respond properly to the insulin that is produced. This form of the disease is more common in people who are older, overweight, and inactive. The often sedentary lifestyle common in many people with type 2 diabetes also interferes with bone health. This is just one of many reasons why older women should stay active and eat a well-balanced, whole foods diet.

Strategies for Prevention and Treatment

With my patients, I apply similar strategies to prevent and treat osteoporosis in people with diabetes as for those without diabetes.

  1. Bones become stronger with weight-bearing exercise such as walking, weight lifting, stair-climbing, and dancing. Regular exercise can also enhance balance and flexibility, and reduce the likelihood of falling and breaking a bone. A dual-energy x-ray absorptiometry (DXA) test, one of the most widely recognized bone mineral density tests measure various parts of the body’s bones including the hip and spine. These tests can detect osteoporosis before a bone fracture occurs and predict one’s chances of future fractures. People with diabetes should talk to their doctors about whether they might be candidates for a bone density test.

Avoid alcohol and cigarettes. Smoking is bad for bones as well as for the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol can also negatively affect bone health. Heavy drinkers are more prone to bone loss and fracture because of poor nutrition as well as an increased risk of falling.

Calcium and Vitamin D. Calcium and vitamin D is important for healthy bones. Vitamin D plays an important role in calcium absorption and bone health. It can be obtained through exposure to sunlight. Older people are often deficient in Vitamin D. Good sources of calcium include low-fat dairy products and dark green, leafy vegetables.

  1. Like diabetes, there is no cure for osteoporosis. However, several medications are approved by the Food and Drug Administration for the prevention and treatment of osteoporosis in postmenopausal women and men. Medications are also approved for use in both women and men with glucocorticoid-induced osteoporosis.

Readers are referred to National Osteoporosis Foundation and National Institutes of Health Osteoporosis Resource Center websites which form the basis of above mentioned information.

Abid Yaqub MD, FACP, FACE, CCD, is the Medical Director of Endocrinology at West Chester Hospital and oversees the UC Health Women’s Center Bone Health program.

Nadia Yaqub, MD, FACP, FACE, ECNU leads the endocrinology program at UC Health Women’s Center.

Schedule an appointment by calling (513) 475-UC4U.

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