Bone Health and Diabetes: What You Need To Know

This content originally appeared on Diatribe. It was reissued with permission.

by April Hopcroft

Important takeouts:

• People with type 1 and type 2 diabetes are at increased risk of developing osteoporosis and experiencing fractures.
• Maintaining a healthy weight and eating a nutritious diet is key to healthy bones. In particular, take plenty of calcium and vitamin D.
• Other ways to reduce the risk of osteoporosis include engaged in regular strength training, receiving recommended screenings, and following blood glucose control.

Unless you’ve broken something recently, bone health may not be the best in your mind. However, keeping your bones healthy is important, especially for people with diabetes who are at high risk for osteoporosis.

Even if you have already been diagnosed with osteoporosis, it is not too late to start building strong bones and prevent breaks. To understand the relationship between bone disease and diabetes, I spoke with Dr. Rasa Kazlauskaite, an endocrinologist with extensive experience in osteoporosis.

What is osteoporosis?

Osteoporosis is a condition that causes bones to become weak and brittle. This increases the risk of fractures, such as falling from a standing position or coughing.

Like your skin, bones are a living tissue that is constantly regrowing. Osteoporosis occurs when old bones are lost faster than new bones can be created. In many cases, people with osteoporosis may not notice symptoms at the early stages. You can’t feel the bones getting smaller and thinner. In later stages you may notice a loss of height, a bent position, or a fracture (typically the spine, hip, or wrist). In many cases, the first sign of osteoporosis is a fractured bone.

“We hear everything about preventing heart attacks, but we don’t hear about the risk of fractures,” Kazulauskite said.

While many people can heal quickly from a break without complications, bone fractures can require long-term needs of crutches, wheelchairs, or pedestrians, especially in older adults. Being immobilized can lead to many different complications and infections, and it can take time to heal with diabetes.

Diabetes-related complications such as neuropathy and vision disorders can also increase the risk of fractures, Kazulauskite said. Peripheral neuropathy, for example, can reduce the strength of the foot and lead to serious falls. Similarly, if it doesn’t look right, you’re more likely to travel and fall.

Risk factors for osteoporosis

Diabetes does not cause osteoporosis, but it can increase your risk of developing it. Having diabetes (type 1 or type 2) also increases the risk of fractures. With type 1 diabetes, people tend to have lower bone density and may have impaired bone formation, both of which can contribute to osteoporosis.

Other risk factors include:

• aging: Bone growth slows as it ages, bone loss occurs faster, increasing the risk of bone disease.
• Biological gender: Women are generally at a higher risk of osteoporosis as they tend to be smaller and have fewer dense bones than men.
• Ethnicity: White and Asian women over the age of 50 are at a higher risk of osteoporosis due to their low bone density.
• Hormonal changes: Women who have experienced menopause are at a higher risk of osteoporosis due to lower estrogen levels (low estrogens reduce bone density. Low testosterone can also increase risk, as testosterone plays a role in maintaining the bones strongly.
• Low weight: People weighing less than 125 pounds are at increased risk of osteoporosis.
• Other Terms: Renal failure, liver disease, inflammatory bowel disease, arthritis, and eating disorders can contribute to the development of osteoporosis.
• medicine: Some drugs can affect calcium absorption and bone formation, potentially increasing the risk of osteoporosis. These include diabetic drugs such as sulfonylureas, thiazolidinediones, and SGLT-2 inhibitors, as well as diuretics (Mizumaru), which are used to manage kidney and cardiovascular diseases.

5 ways to strengthen your bones

Whether you have osteoporosis or are trying to prevent it, there are many steps you can take to maintain your bone health in the long term.

1. Maintain a healthy weight

Weight management is an important aspect of osteoporosis prevention. Loss of weight or living obese increases the risk of thinning bones and fractures.

In general, people with smaller frames tend to have less bone mass, which increases their risk of osteoporosis. Their bones are also likely to become vulnerable with age, Kazurauskite said.

Obesity, on the other hand, can increase the risk of fractures, especially in the tibia (symbone), humerus (upper arm), and ankles. Weight loss, particularly rapid weight loss due to bariatric surgery — can reduce bone mass and increase the risk of osteoporosis.

2. Practice strength training

Strength training (also known as resistance training) is widely seen as a way to build muscle, but it also helps maintain healthy bones and reduce the risk of fractures.

All kinds of weight-bearing exercises (walking, running, dancing, even pickle balls) help to put strength on the bones and strengthen them. Weight-bearing exercises can help stimulate bones and renew yourself, Kazulauskite explained.

A 2022 study found that resistance training in women who have experienced menopause increases bone density. Strength exercises like weightlifting also improve posture and balance, helping to prevent falls. If you are using a free weight or weight machine, it is recommended to start small and accumulate slowly.

Diabetics are at a particularly high risk of ankle and tibia fractures, so make sure to wear appropriate shoes for physical activity. Diabetes-related foot complications, such as Charcot foot, may be related to unnoticed fractures. If you are unable to exercise due to an injury, Kazurauskite recommended programs such as Osteostrong.

3. Eat calcium-rich meals

Remember when you were a child, your milk was told to finish off your milk because it would make strong bones? This is because milk contains calcium, a mineral that helps to form bones and maintain strong bones. Excellent sources of calcium include milk, cheese, yogurt, seeds, beans and lentils, lush greenery and fish.

Kazlauskaite recommended tracking calcium intake through apps such as my Fitness Pal and Mynetdiary. Ideally, you should consume at least 1,000 mg of calcium per day, she said. People who have experienced menopause may have a high need for calcium (approximately 1,200 mg per day).

Supplements can help if you can’t get enough calcium through your diet. Most people start with calcium citrate, but if you experience the side effects of calcium citrate, it is recommended that you consider calcium phosphate, advised Kazulauskite.

4. Get enough vitamin d

Vitamin D is also important for strong bones as it helps the body absorb calcium. A great source of vitamin D includes certain fish such as egg yolks, mushrooms, salmon, tuna and sardines. Several foods are fortified with vitamin D, including milk, orange juice, cereals, and oatmeal.

If you are taking vitamin D supplements, Kazulauskite recommends checking your levels. For osteoporosis prevention, vitamin D levels should be at least 30 ng/ml. Over-the-counter vitamin D supplements are available at most drug stores and grocery stores.

If for any reason the provider is unable to provide vitamin D tests, Kazlauskaite has proposed the website Walkinlab.com. This allows you to sign up for a low-cost test yourself.

5. Get an osteoporosis screening

For people with diabetes, according to the American Diabetes Association, bone density scans are usually recommended when women enter menopause and for men aged 50.

Due to the high possibility of a fracture, diabetics need to be tested for the risk of a fracture, Kazulauskite said. This includes FRAX risk calculator, fall testing, clinical testing and assessments with bone density (DXA) scans.

For people with type 1 diabetes, a DXA scan is recommended every 2-5 years at diagnosis. Bone density tests should include trabecular bone scores (TBS), Kazlauskaite noted.

Treatment of osteoporosis

If you are diagnosed with osteoporosis, treatment may include medication and lifestyle changes. A common drug for treating osteoporosis is bisphosphonates, such as alendronate. Another treatment is denosumab, which is injected every six months. Interestingly, new studies show that alendronate and denosumab may reduce the risk of developing type 2 diabetes.

Hormonal therapy may be recommended for women who have experienced menopause or low testosterone. Just like preventing osteoporosis, a key part of treatment is keeping your bones strong and healthy. This includes regular exercise intake, a nutritious diet and maintaining a healthy weight.

Conclusion

It is not too early to think about osteoporosis and take steps to strengthen the bones. Managing diabetes through healthy lifestyle changes and maintaining blood glucose levels within targeted ranges can go a long way in reducing the risk of complications, including osteoporosis.