Diabetes Management: Keeping Our Bones Strong

Although having fragile bones is not typically listed as a possible diabetes complication, maybe it should be.

Data shows that people with type 2 diabetes have a significantly higher incidence of bone fracture. For instance, they have a 30 to 40 percent greater risk for hip fracture during their lifetime than people without diabetes, according to a 2015 study.

Diabetes and Bone Quality

The reason diabetes is associated with increased fracture risk seems unrelated to bone bone density.

Standard DEXA scans (bone X-rays) show that people with type 2 diabetes generally have as much mineral in their bones as folks without diabetes. This suggests to researchers that the higher incidence of fractures is partly, maybe largely owed to diabetes-related changes in bone quality:

• Research has associated high glucose levels, and poor glycemic control with weaker bones.
• Low blood sugar may inhibit our bone’s rebuilding process.
• Damage to small blood vessels from high blood sugar may limit the nutrients available to our bones for rebuilding.
• Some medications are linked with higher fracture risk, such as TZDs, Actos, and antidepressants—but a causal relationship has not been established.
• People with diabetes may have cellular issues that affect bone remodeling; researchers are looking into this.

While heavier people are generally less prone to osteoporosis than thin individuals, carrying extra weight may not protect individuals with diabetes from a fracture if the disease is compromising their bone strength.

Protective Strategies

Though no one wants to worry about another unpleasant complication, raising awareness about diabetes and bone quality is meant to encourage the adoption of strategies that are bone-protective:

• Good glucose management is the primary way to prevent, or impede the progress of diabetes complications, including bone fragility.
• Know the risk factors for osteoporosis: being thin, family history of the disease, being female, smoking, excessive alcohol, poor diet, and sedentary lifestyle. Having a DEXA scan is a good idea, but realize it may underestimate the risk of fracture for those with diabetes.
• Getting adequate calcium, vitamin D, and magnesium through diet, or via supplementation is vital. Eating a lot of dark green veggies is helpful, so is enjoying a reasonable amount of sunlight exposure whenever possible.
• Regularly engaging in weight-bearing activities, those that make us work against gravity, is an excellent way to strengthen our bones. Remember to stand-up and walk about every 30 to 40 minutes if you have a sedentary job.

Even small, positive changes in our lifestyle, such as eating an extra daily serving of leafy greens, or incorporating planks or pushups into a weekly workout routine can create huge benefits for our bones.

Source: Endocrine Web; Andrew Curry/Diabetes Forecast; NIAMS
Photo credit: Anthony Topper