It is common to hear about the relationship between diabetes and the eyes, kidneys, heart, brain, and feet. Did you know that diabetes can also affect your bone health?
Individuals with Type 1 diabetes (the loss of insulin produced by the pancreas) or Type 2 diabetes (the body’s inability to use insulin and a slow loss of one’s ability to make insulin) have an increased risk of bone fractures and osteoporosis. Associated with decreased bone mass, women with Type 1 diabetes are 12 times more likely to have a fracture than women without diabetes. Although bone mass may or may not be decreased in those with Type 2 diabetes, there is evidence of altered bone quality. The duration of diabetes also plays a role as those living with the condition for more than 5 years tend to be at a higher risk for fractures and poor fracture healing.
Several factors affect the health of our bones, such as calcium, vitamin D and certain hormones. People with diabetes tend to have low vitamin D levels. Vitamin D is an important nutrient that helps the body absorb calcium, which is needed to maintain bone density. Elevated blood glucose levels lead to chronic inflammation which directly affects the quality and strength of the bone.
Healthy lifestyle changes for optimal diabetes control and bone health include:
- Being physically active, which helps keep blood glucose leveled and is important for your bone health. Weight-bearing exercises such as walking, jogging and stair climbing can be important to prevent bone loss and can also build muscle strength to prevent falls.
- Eating well-balanced, nutritious meals. Avoid refined carbohydrate like white bread and sweetened drinks that cause blood glucose levels to spike. Limit caffeine as it may affect calcium absorption. Eating a diet that contains 1,000 to 2,000 International Units (IU) of vitamin D and 1,000 to 1,200 milligrams of calcium can also help prevent bone loss. If your dietary calcium and vitamin D is not enough, supplements can be taken to meet the daily requirement
- Having good diabetes control to prevent complications associated with falling such as nerve damage, vision loss, circulatory problems and hypoglycemia (low blood sugar).
- Quitting all tobacco products. Smoking reduces blood supply to the bones and other organs, increasing the risk of diabetes complications.
- Limiting, if not completely avoiding, alcohol. Alcohol affects all parts of the body, including the bones, and may cause changes in blood glucose levels.
Finally, speaking to your endocrinologist or primary care physician about your risk of osteoporosis and fractures is important to determine if you need other treatments to improve your bone health. People with diabetes should have a bone density test to monitor bone mineral density; every 2 years for post-menopausal women and men over the age of 70. Routine bone density testing is not recommended for men younger than 70 unless they have other risk factors such as loss of more than 1.5 inches in height, long-term steroid use or other factors. Since women have higher risk of osteoporosis, it is recommended that all women above 65 years of age and postmenopausal women younger than 65 years of age with risk factors such as family history or low body weight get a bone density test. Taking action to manage diabetes decreases risk of developing complications and offers protection to bone health.
Jenny DeJesus is a nurse practitioner at HSS.
