The tricky relationship of diabetes and bones

People with type 1 diabetes tend to have a lower bone density and are at an increased risk of osteoporosis, say experts
It is noted that bones in diabetic patients are more porous due to fat deposition-one of the factors for weaker bones. Diabetes leaves an impact on the bone health irrespective of the type. “Osteoporosis is a disorder that causes bones to become weak and prone to fracture. People who have type 1 diabetes have an increased risk of osteoporosis,” says Dr Praveen Mereddy, Consultant Orthopedic Surgeon, Care Hospitals.
Studies have shown that both diabetic men and women equally suffer from high risk of hip fractures and weaker bone conditions. “Osteoporosis is a silent disease and it will not be diagnosed until and unless a fracture occurs. However, there are few factors that may suggest osteoporosis, which includes unexplained weight loss, fractures after little falls, back pain and bone deformities such as curved spine,” explains Dr Elizabeth Philip, Diabetologist, Ortho One Orthopaedic Speciality Centre, Coimbatore.
Research also suggests that women with type 1 diabetes may have an increased fracture risk, since vision problems and nerve damage associated with the disease have been linked to an increased risk of falls and related fractures. Hypoglycemia, or low blood sugar reactions, may also contribute to falls.
“Apart from hip fractures, upper arm and foot fractures are common due to diabetes. Bone related problems occur in both type 1 and type 2. The former is associated with decreased bone mass when compared to latter. It is recommended to have an evaluation of bone density for men above the age of 65 and women after menopause, since diabetes can be a potential cause for osteoporosis,” says Dr Elizabeth.
Type 1 diabetes is linked to low bone density, although researchers don’t know exactly why. Insulin, which is deficient in type 1 diabetes, may promote bone growth and strength. “The onset of type 1 diabetes typically occurs at a young age when bone mass is still increasing. It is possible that people with type 1 diabetes achieve lower peak bone mass, the maximum strength and density that bones reach. People usually reach their peak bone mass by age 30. Low peak bone mass can increase one’s risk of developing osteoporosis later in life. Some people with type 1 diabetes also have celiac disease, which is associated with reduced bone mass. It is also possible that cytokines, substances produced by various cells in the body, play a role in the development of both type 1 diabetes and osteoporosis,” explains Dr Praveen Mereddy.
Diabetic hand syndrome :
While there is an impact on the bones, Diabetes can also affect the joints. Stiffness of shoulder joints – termed frozen shoulder can be a sign of sugars not under control. Other conditions that people suffer from due to diabetes includes Diabetic hand syndrome, also called diabetic cheiroarthropathy, a disorder in which the skin on the hands becomes waxy and thickened. “Eventually finger movement is limited and it even becomes difficult to press the palms together flat. Better management of blood glucose levels and physical therapy can slow the progress of this condition, but the limited mobility may not be reversible,” says Dr Elizabeth.
Similar condition :
Another similar condition is Charcot (shahr-KOH) joint, also called neuropathic arthropathy, that occurs when a joint deteriorates because of nerve damage — a common complication of diabetes. “Charcot joint primarily affects the feet. Also, Vitamin D, which plays a major role in absorption of calcium is low in diabetes. Individuals with Type 2 diabetes, tend to have lower levels of Vitamin D,” says Dr Elizabeth.
Sedentary lifestyle :
Increased body weight can reduce one’s risk of developing osteoporosis. “Since excessive weight is common in people with type 2 diabetes, affected people were long believed to be protected against osteoporosis. However, although bone density is increased in people with type 2 diabetes, fractures are increased. This may again be due to increased falls because of vision problems and nerve damage,” says Dr Praveen Mereddy.
Moreover, the sedentary lifestyle common in many people with type 2 diabetes also interferes with bone health; and the disease disproportionately affects older individuals.
Talking about measures to improve bone health, Dr Elizabeth says, “Leading a healthy lifestyle , regular exercise, controlled diet, controlled blood sugar levels, removing hazards at home and adding non-slip surfaces and handrails in the bathroom reduces the risk of falls along with vitamin D and calcium supplementation.”
Researchers also suspect that the increased fracture risk in people with type 2 diabetes may be due to the negative impact of the disease on bone structure and quality.