Submitted by Elizabeth Madlem, APN, The Bone Health Clinic at Millennium Pain Center
Diabetes is a disorder of metabolism, a term that describes the way our bodies chemically change the foods we eat into growth and energy.
After we digest food, glucose (sugar) enters the bloodstream, where it is used by the cells for energy. For glucose to get into the cells, insulin must be present. Insulin is a hormone produced by the pancreas and it is responsible for moving glucose from the bloodstream into the cells to provide energy needed for daily life. In people with diabetes, the body produces too little or no insulin, or it does not respond properly to the insulin that is produced. As a result, glucose builds up in the blood and may overflow into the urine where it is excreted from the body. Therefore, the cells lose their main source of energy.
According to the Center for Disease Control and Prevention, 29.1 million people have diabetes.
- In type 1 diabetes, the body produces little or no insulin. This form of the disease typically appears in children and young adults, but it can develop at any age.
- In type 2 diabetes, the body produces insulin but not enough, and the body does not respond properly to the insulin that is produced. This form of the disease is more common in people who are older, overweight, and inactive.
Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis can result in pain and disability. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass.
Risk factors for developing osteoporosis include the following:
- being thin or having a small frame
- having a family history of the disease
- for women, being postmenopausal or having an early menopause
- using certain medications, such as glucocorticoids
- not getting enough calcium
- not getting enough physical activity
- smoking
- drinking too much alcohol.
Osteoporosis is a disease that often can be prevented. If undetected, it can progress for many years without symptoms until a fracture occurs.
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. 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.
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.
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. Although bone density is increased in people with type 2 diabetes, fractures are also increased. As with type 1 diabetes, this may be due to increased falls because of vision problems and nerve damage. Moreover, the sedentary lifestyle common in many people with type 2 diabetes also interferes with bone health, and the disease disproportionately affects older individuals. Researchers 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.
It’s important to be aware of this connection between diabetes and osteoporosis since osteoporosis does not exhibit any symptoms. If a person is diagnosed with diabetes, they should also take steps to prevent and treat osteoporosis. The following strategies are helpful for everyone, but are especially important for people seeking to treat and prevent both diabetes and osteoporosis.
Nutrition. A diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Many low-fat and low-sugar sources of calcium are available. Also, supplements can help you meet the daily requirements of calcium and other important nutrients. Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. Although many people are able to obtain enough vitamin D naturally, older individuals are often deficient in this vitamin due, in part, to limited time spent outdoors. They may require vitamin D supplements to ensure an adequate daily intake.
Exercise. Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercise for your bones is weight-bearing exercise that forces you to work against gravity. Some examples include walking, stair climbing, and dancing. Regular exercise can help prevent bone loss and, by enhancing balance and flexibility, reduce the likelihood of falling and breaking a bone. Exercise is especially important for people with diabetes since exercise helps insulin lower blood glucose levels.
Healthy lifestyle. Smoking is bad for bones as well as for the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol can also negatively affect bone health. Heavy drinkers are more prone to bone loss and fracture because of poor nutrition as well as an increased risk of falling. Avoiding smoking and alcohol can also help with managing diabetes.
Medication. Like diabetes, there is no cure for osteoporosis. However, several medications are approved by the Food and Drug Administration for the prevention and treatment of osteoporosis in postmenopausal women and men. Medications are also approved for use in both women and men with glucocorticoid-induced osteoporosis.
It’s important for everyone to take control of their health — and this includes bone health. If you are diagnosed with diabetes or osteoporosis or have many risk factors for developing either disease, a comprehensive osteoporosis treatment program that includes a focus on lifestyle changes can be very beneficial in helping you to improve your health.
For more information on bone health and osteoporosis, you may contact The Bone Health Clinic at Millennium Pain Center, 309-662-4321. They have a new location at 2406 E Empire St. in Bloomington. Elizabeth Madlem is a certified bone health consultant. The clinic provides screening, diagnosis, and a comprehensive treatment plan for people who have or are at risk of developing osteoporosis.