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How does diabetes affect bone health?

By Apollo 24/7, Published on - 24 February 2021

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Type-2 diabetes is one of the most widespread chronic diseases in the world. If left untreated or undiagnosed, diabetes can affect various vital organs of the body. Diabetes is known to be a risk factor for both microvascular (retinopathy, nephropathy, and neuropathy) and macrovascular (cardiovascular diseases) complications. However, recent studies have shown that diabetes also affects bone health and increases the risk of fracture in diabetic patients.

Diabetes and bone health

Several studies have established that people with diabetes (both type 1 and type 2) are at increased risk of bone fracture as compared to the general population. Research published in 2016 stated that there is a 7-fold increase in hip fractures in people suffering from type 1 diabetes. In type 2 diabetes, the risk is increased by 1.3 times, despite having above-average bone density.

According to a study published in the journal Hindawi, multiple causes can be attributed to bone damage in people with diabetics. The following clinical indications were found in persons diagnosed with diabetes:

  • Reduced release of Insulin-like growth factor-1 (IGF-1), which otherwise promotes the growth of skeletal muscles, bones and cartilages
  • Increased oxidative stress in the body
  • Increased glycation, where sugar molecules start binding to proteins and fats
  • Reduced absorption of calcium in the body
  • High levels of parathyroid hormone, which indicates that there is a lack of calcium
  • Discharge of calcium in the urine (hypercalciuria)

These can result in decreased bone strength and quality, and increased risk of fracture. Consequently, such changes put diabetics at risk of developing bone diseases such as osteopenia and osteoporosis.

Which bone diseases are more prevalent in diabetics?

There are certain bone diseases that are more prevalent in people suffering from diabetes:

  • Osteoporosis: Extremely weak bones due to low bone mineral density
  • Osteoarthritis: Wearing down of the protective covering of the joints, called cartilage
  • Neuropathic arthropathy (Charcot joint): Deterioration of joints due to diabetes-related nerve damage (neuropathy), which results in numbness, and loss of sensation in the extremities
  • Diffuse idiopathic skeletal hyperostosis: Pain and stiffness in the back or neck due to hardening of the ligaments and tendons that attach to the spine
  • Frozen shoulder: Reduced range of motion of the shoulder accompanied by pain and sometimes swelling
  • Diabetic hand syndrome: Thickening of the skin on the hands, making it difficult to move fingers or press the palms together
  • Dupuytren’s contracture: Thickened and scarring of the tissues beneath the skin of the palm and fingers resulting in the deformity of the hand.

What can be done to maintain bone health in diabetics?

Bone health can be strengthened by adopting a series of healthy behaviours, some of which are:

  • Exercising: A study revealed that diabetic women, who practiced moderate-intensity exercises for at least 4 hours a week, had a 40% reduced risk of developing heart disease. Weight-bearing and strength training is considered being the best form of exercises to strengthen the bones and the surrounding muscles.
  • Eating a healthy diet: Consuming a diet filled with leafy vegetables, fruits, whole grains, legumes, lean meats, fish, nuts and seeds, and low-fat dairy products is essential to maintain bone health. Diabetics must ensure they get enough calcium and vitamin D every day, as it is important for healthy bones.
  • Modifying lifestyle: Diabetic women must quit smoking as it can make them enter menopause early, putting them at risk of a bone loss earlier than usual. Smoking also reduces the absorption of calcium in the body. Similarly, alcohol can also negatively affect bone health as heavy alcohol consumption reduces bone density and increases the risk of osteoporosis.
  • Controlling blood sugar: Controlled diabetes can prevent complications such as nerve damage, circulatory problems and vision loss, which can otherwise increase the risk of falling. Controlled blood sugar also improves calcium absorption in the body. 

What exercises can help in improving bone health?

Research shows that exercising regularly can reduce the levels of HbA1c (average blood sugar levels of three months) in people with impaired blood glucose. While all forms of exercise can help in reducing blood sugar, there are certain exercises that can especially improve bone health in diabetics. These include:

  • Weight-bearing exercises: Exercises such as walking, jogging, climbing stairs, playing tennis, and dancing allow a person to work against gravity. These exercises improve the absorption of insulin, increase energy stamina, improve bone strength, and reduce risks of cardiovascular diseases.
  • Resistance exercises: Exercises such as squats, lunges, deadlifts, pull-ups and push-ups cause the muscles to contract which increases the strength and mass of the muscles and bones.
  • Aerobic exercises: Aerobic exercises such as Zumba, swimming and water aerobatics help in strengthening the muscles of the body, which increases bone density. Aerobic exercises also improve the production of insulin in the body.

Takeaway

Exercising regularly can help the body in several ways. It helps in maintaining weight, lowers the levels of bad cholesterol and triglycerides, strengthens bones and improves mood. It has also been established that exercising can also lower blood sugar levels and improve the absorption of insulin, thus reducing insulin resistance in the body.

People suffering from diabetes must talk to their endocrinologist to determine their risk of developing a bone disease or fractures, and to identify ways to improve their bone health.

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