The Link Between Diabetes and Bone Health
“Diabetes affects bone health by reducing bone density as well as quality,” says Dr Pulak Vatsya, consultant in sports orthopaedics and robotic joint replacement and former senior resident at AIIMS, New Delhi.
Type 1 diabetes, also known as insulin-dependent diabetes, is a condition in which insulin deficiency leads to hyperglycemia in young people. In addition to the usual neurological complications, both men and women with type 1 diabetes exhibit low bone mass in the hip, femoral neck, and spine, which can ultimately lead to an increased rate of fractures.
In contrast, in type 2 diabetes (non-insulin-dependent diabetes), there is an increase in bone density at the femoral neck. However, hip bone density is significantly lower in patients with type 2 diabetes compared with age-matched controls. Furthermore, people with type 2 diabetes have an increased risk of fractures at several sites, including the spine and hip.
Mechanisms affecting bone health in diabetic patients
Hyperglycemia: When blood sugar levels remain consistently high, the collagen in connective tissues becomes glycated (sugar molecules bind to proteins and affect the structural matrix). This makes bones much more brittle and more prone to fracture.
Insulin resistance: Insulin, a hormone secreted by the pancreas, is necessary for the activity of bone-building cells and aids bone formation. But in diabetes, insulin resistance occurs and this activity is impaired, weakening bones.
Inflammation: Diabetes is a metabolic disorder associated with inflammation, which can directly affect bone remodeling.
Diabetic neuropathy: This condition weakens the nerves and leads to loss of sensation, causing frequent falls.
How to Manage Bone Health in Diabetics
Regular bone check-ups: People with long-term diabetes or uncontrolled blood sugar should go to the hospital for regular bone check-ups.
Diet rich in calcium and vitamin D: For healthy bones, you need to consume calcium-rich foods such as dairy products and for better calcium absorption, vitamin D is needed. To get enough vitamin D, you should consume foods such as fatty fish, egg yolks or supplements.
Weight-bearing exercise: To strengthen bones and reduce the risk of frequent falls, people with diabetes should regularly participate in weight-bearing exercises such as jogging, walking, and weight training. In addition, another added benefit of exercise is increased insulin sensitivity, which helps control blood sugar better.
Blood sugar control: Most musculoskeletal problems in diabetic patients arise from poor blood sugar control. Therefore, diabetic patients should be aware of this and regularly participate in physical activities, eat healthy foods and take their oral hypoglycemic drugs (OHA) on time as prescribed by their doctor.
