Bone health and diabetes: how are they related?

Diabetes slows down the healing process. The immune system is disrupted, so people with diabetes are susceptible to infections and other potential complications. Healing of bone fractures can be prolonged for 87 percent for people with diabetes, including a higher risk of healing complications.

Numerous factors that are part of life with diabetes also mean a higher risk broken bones.

• Low blood sugar. Also known as hypoglycemia, episodes of low blood sugar are often accompanied by symptoms that include fainting, disorientation, and instability. Their falls due to dizziness can lead to bone fractures.
• Hyperglycemia. In the long run, elevated blood glucose levels can contribute to bone fragility by producing more advanced glycation end products (AGEs). Accumulation of AGE was observed together with reduced bone formation in rats with hyperglycemia.
• Complications of diabetes. Those with diabetes-related complications face a higher risk of bone injury, including those with reduced vision (caused by a condition called retinopathy) and nerve damage (neuropathy) in the feet or legs, making it difficult to navigate through potential falls. .
• Medications. Diabetes medications can lead to a higher risk of bone fractures. Insulin, in particular, has this potential due to its glucose-lowering effects that can lead to hypoglycaemia. Everyone with T1D must take insulin manually replace what their bodies do not produce naturally, and many people with type 2 diabetes (T2D) also take insulin by injection, insulin pump, or inhaled insulin. Other diabetes medications, such as those aimed at lowering blood pressure, can cause dizziness and increase the risk of bone damage.
• Comorbidities. People with diabetes often live with other health conditions, such as thyroid disease, celiac disease and rheumatoid arthritis. These comorbidities have mechanisms that are associated with a higher risk of bone fractures.

The primary impact of diabetes complications on bone health is twofold:

• impairment of physical stability and movement in ways that lead to a higher risk of falls
• obstructing blood flow in a way that undermines the way bone mass is created and maintained

The complications of diabetes that are most commonly associated with bone health are as follows:

Retinopathy

Decreased vision that comes with retinopathy, when blood vessels in the back of the eye are damaged, can lead to confusion and dizziness and a higher risk of falls and fractures.

In addition, loss of vision can make a person feel less confident in their physical movement as a whole. In response, the person reduces movement and exercise, which leads to weakening of bones and muscles.

In a Korean study, a “significant” association was found between the presence of diabetic retinopathy and a decrease in bone mass density and an increased presence of osteoporosis in women. This finding was significant enough that researchers suggested that retinopathy could be considered a marker for decreased bone mass density. Interestingly, the same association was not observed in men.

neuropathy

Nerve damage caused by neuropathy undermines bone health in two ways: by causing more falls and by interfering with blood flow to the bones. With neuropathy, the ability to feel sensations in the extremities and physical coordination are impaired. Together, this increases the risk of falls and fractures. In addition, neuropathy can disrupt blood flow to the bones, interrupting the body’s processes that create and maintain bone mass, leading to weakening of the bones over time.

Nephropathy

How renal function deteriorates in nephropathy, the body’s ability to filter blood waste and regulate hormones that control bodily functions is reduced. Both of these effects disrupt the normal mechanisms that build and maintain bone mass and strength. Over time, the body’s ability to repair bone mass and tissue is undermined.

While people with both major types of diabetes experience a higher overall risk to their bone health, important differences have been observed.

Those with T1D have a higher risk of fractures at an earlier age. It is believed that this is due to changes in their bone mass it seems to happen in youth. Insulin is an anabolic agent for bones, which means that it contributes to bone building, so a lack of insulin contributes to low bone formation.

The increased risk to bone health in people with T2D is related to how long they have been diagnosed and how much insulin they use. The longer they experience hyperglycemia, the more likely they are to show signs of weakening bones.

For both types, hyperglycemia can contribute to bone fragility by producing more AGE along with oxidative stress. Both of these factors are associated with a reduced rate of bone formation.

Yes. Traumatic injuries, such as broken bones, can lead to stress hyperglycemia. This effect may be present with or without diabetes. Since hyperglycemia can prolong and undermine the recovery of blood glucose levels, it is necessary to carefully monitor and manage when you are recovering from a broken bone.

Most broken bones are immobilized with a cast or prosthesis. This will limit your ability to move and use the broken part of your body.

Follow your doctor’s instructions and take time to rest and heal. You will most likely be told to rest and avoid putting weight or stress on a broken bone.

If there are symptoms of complications (swelling, unusual sensations such as heat or numbness, bleeding, etc.), seek help immediately.

There are several things you can do to improve bone health.

• Manage your blood glucose levels. Chronic hyper- or hypoglycemia undermines bone health and increases the risk of bone fractures. Strict glucose management minimizes their effect.
• Training. Regular exercise (aerobic and weight bearing) strengthens your bones and circulation. This supports the maintenance of bone mass and strength. Exercise can also improve your sense of balance, reducing the risk of falls.
• Eating. Food choices are a big part of living with diabetes. A balanced meal plan can consist of a balanced mix of macronutrients, vitamins and minerals and support general health and bodily processes that build and maintain bone and muscle strength. Calcium, magnesium and vitamins D and C are especially important. When using dietary supplements (such as calcium or vitamins), talk to your doctor about the appropriate amounts to take.

Bone health is another aspect of the body that can be negatively affected by diabetes. This is due to medications, including insulin, as well as complications associated with diabetes that lead to a higher risk. Many things that are suggested to keep bones healthy and strong are easily linked to things that people with diabetes are already advised to do to manage their overall health, including glucose management, a balanced diet and regular exercise.