Diabetic Osteoporosis (DOP) is one of the main chronic complications of diabetes. Patients often have comorbid symptoms of osteopenia, bone tissue microstructural damages and bone fragility increase. As a consequence, osteoporosis and osteoporotic fractures frequently occur in the diabetic population. About one-third of elderly patients with femoral neck fractures (FNFs) and vertebral compression fractures (VCFs) have diabetes.
Why do osteoporosis and osteoporotic fractures frequently occur in the diabetic population?
Most diabetics have symptoms of polydipsia, polyuria, glycemia and glycosuria. A large amount of calcium (Ca) and phosphorus (P) excreted in the urine can easily lead to negative calcium balance in patients. Bioactive Vitamin-D (Calcitriol) deficiency and high sugar levels will first affect the absorption of calcium in the gut.
Besides that, diabetics are lack of insulin which is not only a hormone that balances blood sugar in the body, but also promotes the proliferation and differentiation of osteoblasts. When insulin is deficient in the body, osteogenesis is impaired and bone formation is reduced.
Moreover, complications in diabetic patients can also have an impact on bone metabolism.
- Diabetic neuropathy causes loss of muscle mass, loss of strength, and symptoms of gait and standing instability.
- Concurrent retinopathy or low blood sugar can lead to reduced vision, dizziness and even blindness.
- Concomitant microvascular disease affects the blood supply to the bone and is not conducive to bone remodeling.
Some antidiabetic drugs (Thiazolidinediones) may also negatively affect bone metabolism.
Clinical manifestations of diabetic osteoporosis.
Early-stage patients are often asymptomatic. However, as the disease progressed, the patient gradually developed low back pain, accompanied by radiating pain and numbness in the limbs. The condition is often induced or exacerbated by prolonged sitting, standing for long periods of time, holding heavy objects, or being tripped over.
The further development of the disease will lead to hunchback deformity, short height, limb weakness, calf cramps, lameness and other symptoms. In severe cases, spontaneous fractures may occur or fractures may occur under the action of mild external force (such as coughing, sneezing, bending over, weight-bearing, crushing or falling, etc.). The most common fracture sites are the thoracolumbar spine, hip and wrist.
The hazards of diabetic osteoporosis.
The biggest and most serious hazard is the susceptibility to fractures. The risk of refracture is greatly increased, which is dangerous and has a high disability rate. Diabetic patients are prone to complications such as thrombosis, infection and cardiovascular and cerebrovascular diseases after fracture. People with diabetes are at increased risk of developing infection or pressure ulcers if they undergo surgery after fractures that do not heal.
How to prevent diabetic osteoporosis
- Control your blood glucose level.
Keep the A1C value between 6.5% ~ 7.0%. Steady control of sugar, avoid hypoglycemia, reduce diabetes-related complications. Controlling your diabetes actively and effectively is the key to preventing diabetic osteoporosis.
Patients should use drugs that do not affect bone metabolism as much as possible, and avoid drugs that can cause osteoporosis (such as thiazolidinediones).
- Skip fad diets and make healthier choices.
Diabetic patients should eat more calcium-rich foods, such as milk, beans, fish, shrimp, kelp, etc. Adequate daily calcium (Ca) and Vitamin-D supplementation is beneficial for the prevention and treatment of osteoporosis.
The appropriate calcium intake for adults is 800-1000 mg/day, and it can be appropriately increased to 1000-1200 mg/day for postmenopausal women and elderly patients.
Quit smoking, quit drinking, drink less coffee, strong tea and carbonated drinks, eat less sugar and less salt. For the elderly, measures such as anti-fall, anti-collision, anti-tripping and anti-bumping should be strengthened.
- Be more physically active and do more cardio-respiratory exercise.
Regular aerobic exercise, such as jogging, brisk walking, swimming, tai chi, yoga, etc., can not only help diabetics control blood sugar and weight, but also promote the deposition of calcium in the bones and effectively prevent osteoporosis.
In conclusion, the incidence of diabetes and osteoporosis is high, and both are often associated. Diabetes needs to be treated, and osteoporosis needs to be treated even more. The treatment of diabetic osteoporosis has a faster onset, a relatively short course of treatment, and a more obvious effect.
As a diabetic, in addition to controlling blood glucose levels, paying attention to complications such as kidney disease, fundus disease, cardiovascular and cerebrovascular disease, lower extremity vascular disease and foot disease, we also need to care about our increasingly loose bones.
The risk of osteoporotic fractures in diabetic patients is more serious than that in non-diabetic patients. As a consequence, diabetics should be screened for osteoporosis as soon as possible for early detection and early intervention to minimize the risk of osteoporosis.
Author: Ling-Qing Yuan
Current Position: Professor, Senior Doctor of the Department of Endocrinology and Metabolism, Distinguished researcher of the Second XiangYa Hospital, Central South University
Skills and Expertise: Diabetes; Bone Metabolism; Bone Biology; Osteoporosis; Bone Resorption; Bone Mineral Density; Fracture; Articular Cartilage; Bone Regeneration
Ling-Qing’s Homepage: https://orcid.org/0000-0001-8602-7113
Note: All information on Sinocare blog articles is for educational purposes only. For specific medical advice, diagnoses, and treatment, consult your doctor.