The Bare Bones on Diabetes and Osteoporosis

Diabetic Bone Disease

Diabetic bone disease, also known as osteoporosis caused by diabetes mellitus, is a chronic disorder that weakens bones and increases the risk of frequent breaks. 

According to the Mayo Clinic, individuals with type 1 diabetes (T1D) are at an increased risk for bone and joint disorders. Though the causes aren't clear, complications like nerve damage, arterial diseases, and kidney disease may contribute to the reduction in bone mass.

Bone Formation

Bones are created from living tissue that is constantly being broken down, reabsorbed, and replaced with new bone. The entire skeletal system is replaced approximately every 10 years, though the process slows as we age.

Bone Strength

Our bones are vitally important as they provide us with a durable structure that keeps us upright and offers protection to many of our vital organs. With the combination of 206 bones in our body (as adults), we are able to move and remain stable because of them. Nevertheless, that's not the only thing that bones do for us.

Our Bones' Body Function

They also assist and execute many other important jobs:

• They house bone marrow, which makes our blood cells.  
• Bones store growth factors and minerals such as calcium that build and maintain the bones.  
• They work together with the muscles to hold up the body when we stand and move.
• Bones also release factors into the blood that are necessary for the normal functioning of soft organs such as the kidneys.  Chronic kidney disease (CKD) may contribute to low bone mass, causing lower levels of calcium, phosphorus and vitamin D.   

Type 1 Diabetes and Broken Bones

Is There a Connection?

Studies show that diabetic patients have an increased risk of bone fractures. Osteoporosis (low bone mass) is the most common bone disease characterized by the weakening of the bone tissue, structure and strength, which leads to an increase in fractures. Consequently, the prevalence of this is often seen at higher rates and appears more frequently as T1Ds tend to suffer more from osteoporosis.  

One study from the National Institutes of Health concluded that insulin deficiency is the primary cause of osteoporosis in T1D individuals. High blood glucose levels put T1D patients at an osteoporosis risk.

Hyperglycemia (High Blood Glucose Level)

Hyperglycemia, or high blood sugar, can disrupt bone structure and impair bone formation, causing lower bone density. More NIH research suggested that the risk of hip fractures increased sevenfold compared to people without diabetes.  

Hypoglycemia (Low Blood Glucose Level)

Similarly, hypoglycemia, or low blood sugar, may contribute to a decline in bone mineral density and increase the risk of falls and fractures in people with diabetes. Other diabetes complications, such as neuropathy, can also increase the risk of falls

Scientists are uncertain why this happens more frequently with T1Ds. "The exact mechanisms for poor bone health in people with diabetes are unclear. For a given bone mineral density (BMD), diabetic bone tends to be more fragile, and there's a lot of research going on to figure out why. It's possible that changes in bone metabolism and structure, as well as BMD, may worsen bone quality."

Although no formal recognition of the reason for higher bone fracture rates in type 1 diabetics, bone fragility does appear that poor glycemic control is a contributing factor for osteoporosis risk.

Other Bone Fracture Factors

• How long you've had diabetes. The longer you've had diabetes contributes to bone metabolism, bone structure, cell function and blood flow.
• How well you manage your blood sugar time in range.
• Your insulin therapy and severity of blood sugar drops.

Interesting Fact: The latest evidence from the NCBI indicates that chronic high blood sugar causes more bone loss in diabetes patients than low blood sugar.

Enlist Your Doctor's Help

Bone Density Test

If you're concerned about your bone health or your risk factors for osteoporosis, discuss this with your healthcare provider. They can order a bone density test that helps gauge where your bone density currently is and determine your rate of bone loss. By assessing this bone information and your risk factors, they can assess whether you are a candidate for medication to help slow bone loss.

Furthermore, to ensure that our bones stay healthy, everyone, especially those with bone-challenging T1Ds, needs to be proactive about helping their bones stay strong and healthy.  To do this, it is critical to maintain healthy blood pressure and cholesterol levels and keep blood sugar levels close to a normal range.

Ideally,  you'll want to be within a normal range, which is 99 or below, for a perfect fasting blood sugar. With constant highs and lows, bone health suffers, and this escalates the bone fracture risk. Keeping glucose levels in a tight range helps to minimize the negative effects and keep bones healthier.  

Healthy Bones

How Can We Help Build Them?

What exercises are best for bone health? Using a combination of exercises is best for building and maintaining healthy bones and preventing falls and fractures. This contributes to:  

• Strengthening bones and muscles in children and adults.
• Preventing bone loss as we get older.  
• Benefiting us by making bone denser and replacing old bone with new bone.
• Improving one's balance and coordination.
• Preventing osteoporosis, falls, and fractures.

Get Moving!

Getting up and being active plays a significant role in keeping our bones healthy. Weight-bearing and cardiovascular (walking, hiking, bike riding, dancing, running, etc.) exercise helps to improve our bone health with movement and aids in preventing falls and injuries.

In addition, it is recommended that we all do at least 150 minutes (2.5 hours) or more of moderate-intensity movement each week. Resistance training will make muscles work harder as we become stronger. This can be done using resistance bands, hand weights, weighted balls, machines or any other form that works best for you.  

Addition Tips for Healthy Bones

Getting Stronger!

Strong bone health is essential throughout life, and there are always ways to help us strengthen our muscles and bones.  

• Physical activity helps build and strengthen everyone's bones and muscles. TODAY is a good day to get in shape and increase bone mineral density! Even if you haven't done a lot recently, start by strengthening as much peak bone mass as you can do today and add more each following day.
• Increase the amount of good nutrients in your diet by incorporating leafy greens and other vegetables, low-fat dairy, protein, fortified juices, tofu and grains, which are good sources of calcium that support bone health.  
• Protein and calcium are vital sources of nutrition that contribute to your strength and bone health throughout your life.  
• Vitamin D intake. Vitamin D and calcium encourage bone health by helping us absorb the calcium we get from food. Additionally, taking a vitamin D supplement may help protect older adults from bone turnover in postmenopausal women and promote the healthy function of our muscles and immune system.  
• Equally important is avoiding smoking and limiting alcohol consumption.  
• Work to reach and maintain your ideal body weight. The CDC's healthy weight recommendation is available here.  
• Include a calcium-rich food at each meal or snack, and speak to your health care provider about getting the recommended amount of vitamin D.
• Also vital is to maintain a good nights rest. Sleep is important for bone health as it's the body's natural regeneration and repair time. Read these 8 Tips to Help You Sleep Better.

Other Ways We Can Protect Our Bones

It does matter what we eat. Foods that are high in calcium and rich in vitamin C do make a difference in our bone mineral density. Start now by including a balanced diet that contains proteins, plant milks like rice and soy milk can be fortified with calcium.

Besides smoking, a lack of physical activity and medical disorders like arthritis and kidney disease, the main risk factors for low bone mineral density were a poor diet, low in vitamins and calcium.

Bone Healthy Choices

There are a variety of foods that provide bone-healthy benefits:  

• Almonds – they have heart-healthy benefits and 190 mg of calcium in half a cup
• Canned salmon – has 180 mg of calcium for a 3 oz serving
• Dried figs – just two figs contain about 65 mg of calcium
• Soybeans – 1 cup has 30.2g of protein per cup
• Low-fat dairy, such as milk and yogurt  
• Plant milk – 8 oz of unsweetened almond milk has 1 gram of protein and 481 mg of calcium  
• Green vegetables such as kale, broccoli, spinach and more  
• Grains – Amaranth, quinoa, wild rice and other grains have a significant amount of protein  

Be Careful!

Cox Proportional Hazards

The Cox proportional hazards regression model is a common tool for studying the systematic review between survival time and predictor variables. Risk factors can be continuous variables like age, protein level, gender or diabetes. Another NIH cohort study has shown an adverse relationship between diabetes and bones, but there are simple things you can do to help prevent bone loss and promote bone health. Another retrospective cohort study indicates that maintaining a healthy bone weight puts you at a lower risk, while smoking and excessive alcohol use put you at a higher risk. The hazard ratio for diabetes decreases with healthy lifestyle choices.

The Bare Bones of It

It's important to remember that type 1 diabetes can be managed, and you can live a long, healthy life by taking care of yourself and being aware of your surroundings. Take precautions, use handrails when possible and work to strengthen the bones you have now. T1D and T2DM patients may have an increased risk of falls associated with diabetes complications like vision changes or neuropathy (numbness, tingling or joint pain).

Speak with your health care provider and start an exercise and diet regime right for you. It may be a bit more challenging at times, but it can be done. You can also schedule an appointment with a registered dietitian or diabetes educator to create the best plan to manage your bone health. As professionals, they have the knowledge to help you.