MAY IS OSTEOPOROSIS AWARENESS AND PREVENTION MONTH…IS DIABETES A RISK FACTOR?

Osteoporosis is “the most common bone disease in humans”, according to the Bone Health and Osteoporosis Report by the Surgeon General. It is a progressive deterioration of the bone’s integrity, and while it is frequently age-related, its development and severity are influenced by a number of factors, such as diet, heredity, race, medications, and other diseases, including diabetes. The metabolic changes and side effects of diabetes have a negative impact on bone health and are therefore considered risk factors for osteoporosis.

WHAT IS OSTEOPOROSIS?

Osteoporosis is a bone-thinning disease that causes the bones to become weak and brittle, affecting both men and women. It is defined as low bone mass density (BMD) and is characterized by weakened bone structure and strength. The holes and spaces in the matrix of the bone become larger, making the bone more fragile and likely to break.

Primary osteoporosis is what we commonly call age-related osteoporosis. It is a compilation of normal bone loss over time, reduced absorption of calcium and vitamin D, and decreased physical activity. Osteoporosis can be seen in all bones but is commonly seen in the hip, wrist, and spine.

Secondary osteoporosis is a consequence of other diseases, disorders, or medications and typically results in more bone loss than primary osteoporosis.

Osteoporosis is usually diagnosed by a DEXA scan, an imaging test to measure bone density. Results are given as a T score which compares an individual’s bone density with that of a healthy young adult.

WHO IS AT THE HIGHEST RISK?

Women are 2-3 times more likely to develop osteoporosis than men. The decrease in estrogen levels, seen after menopause, results in a dramatic reduction in BMD. This decline later slows to a more gradual loss, as is seen in men.

Women, as well as petite adults, tend to have a smaller frame and lower weight and generally have lower BMD readings. They are at a higher risk for osteoporosis as they have less bone mass to draw from later in life.

Other factors that increase risk are:

-an unhealthy diet low in calcium and vitamin D,

-lack of physical activity

-excess alcohol consumption

-cigarette smoking

-Being Asian-American

-Long-term use of certain medications such as steroids, protein pump inhibitors (PPIs), antidepressants, antiseizure medications, some cancer treatments, certain blood thinners, hormonal contraceptives, and Thiazolidinediones (TZDs).

-Disorders that result in malabsorption of calcium, vitamin D, and other important nutrients, such as inflammatory bowel disease, and celiac disease.

WHAT IS THE DIABETES-OSTEOPOROSIS LINK?

The link between diabetes and osteoporosis is complex. The connection may be related to the duration of the disease and the consequence of poorly controlled blood sugar and kidney disease.

DURATION OF DISEASE

Studies find that those with long-standing diabetes (greater than 5 years) have a lower bone mineral density than those without diabetes. Evidence points to the metabolic changes of diabetes that alter bone quality over time, and the calcium imbalance resulting from impaired kidney function.

Additional studies find individuals with type 1 diabetes to have a lower bone mineral density since type 1 diabetes often strikes at a young age, and at a time when bone density and strength are increasing. Optimal peak levels may not be reached, which increases the risk for osteoporosis later in life.

About 10% of people with type 1 diabetes also have celiac disease, which is often associated with reduced bone mineral density due to malabsorption.

POOR GLUCOSE CONTROL AND KIDNEY FUNCTION

Studies also find a correlation between poor glucose control and an increased risk of osteoporosis. The elevated blood glucose levels present in diabetes result in chronic inflammation and oxidative stress which negatively affect all cells, including the quality and strength of bone, as well as bone formation.

An article published in the Journal of Clinical Diabetes cites a study that found bone loss to be greater in patients with poorly controlled diabetes than in those well-controlled and relates this to the vascular changes typically seen in diabetes.

Chronic high glucose levels impair kidney function. Unhealthy kidneys cannot adequately balance calcium and phosphorous levels in the blood. They are unable to activate a form of Vitamin D into a form of calcium that bones can use, thereby increasing the risk of osteoporosis.

HOW CAN I PREVENT OR LIMIT THE IMPACT OF DIABETES ON OSTEOPOROSIS?

Maintaining well-controlled blood sugar levels is best for all body functions, including bone health. Try to:

-Keep blood sugars well controlled by simplifying meal planning with the Diabetes Plate Method. Fill one-half of the plate with non-starchy vegetables, one-quarter with lean protein, and one- quarter with high fiber carbohydrate foods. Choose water or a low-sugar beverage.

-Include rich sources of calcium and vitamin D such as low-fat dairy products, including yogurt, milk, and cottage cheese, as well as dark green leafy vegetables, and calcium-fortified foods and beverages. The National Osteoporosis Foundation (NOF) recommends adults receive 1,200 mg/day of elemental calcium and 400–800 IU/day of vitamin D from food or supplements.

-Maintain a healthy weight. Obesity increases the risk of developing diabetes and the risk of diabetes complications. However, being underweight results in less bone mass.

-Exercise daily to control blood sugars and strengthen bones. The best exercises for bone health are weight-bearing and resistance exercises. Weight-bearing exercises work against gravity and include walking, jogging, dancing, and climbing stairs. Resistance exercises work against your own body weight and include squats, push-ups, weight lifting, and planks.

-Avoid smoking as it raises blood sugar and may make cells more resistant to insulin. It also reduces calcium absorption which is necessary for bone health. The toxins in cigarette smoke damage blood vessels and decrease the flow of oxygen.

-Limit alcohol. Alcohol can play havoc with blood sugar levels causing either highs or lows. It also raises triglyceride levels and blood pressure, increasing the risk of diabetes complications. Alcohol interferes with calcium balance and the production of Vitamin D needed for bone health.

-Maintain a close relationship with your doctor or healthcare provider. Having regular visits to monitor your A1C, blood pressure and cholesterol levels will allow him or her to adjust your diabetes treatment plan as needed. The better your diabetes is in control, the better your chances are of reducing the risk and severity of osteoporosis.

THE TAKEAWAY

We don’t usually think about a link between diabetes and osteoporosis, however, the metabolic changes of diabetes have been associated with negatively impacting bone health and increasing the risk for fracture. Keeping blood sugars well controlled, avoiding a sedentary lifestyle, and engaging in regular physical activity are steps to reducing that risk. Habits such as smoking and alcohol should be avoided.

Aim to increase your Calcium and Vitamin D intake to 1,200 mg/day of elemental calcium and 400–800 IU/day of vitamin D from food or supplements. And have regular visits to your healthcare provider to discuss your risks and need for screening.

If you would like help with preventing or managing diabetes, consider a One-on-one Nutrition Counseling session with one of our experienced registered dietitians or join the Diabetes Prevention Program (DPP) designed to help you make better food choices and decrease your risk for developing diabetes. Additionally, our Diabetes Self-Management Education and Support(DSME) group helps improve your skills for managing blood sugars to reduce your risk for developing diabetes-related complications. Schedule an Appointment Today! (240) 449-3094. Many of our services are covered by insurance.