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Diabetes and Osteoporosis Risks

Diabetes and Osteoporosis RisksDiabetes mellitus, commonly known as sugar diabetes, is a condition with poor control of blood glucose levels. It has far reaching effects on various organs of the body including the bone. Diabetes can also impact on the bone and even contribute to conditions such as osteoporosis. This link is more significant in seniors as age-related changes in bone as well as the difficulty controlling diabetes in the elderly compound bone health. Postmenopausal women are the most affected due to the detrimental effect of declining estrogen levels.

How does diabetes affect bones?

Bone health is affected in different ways in type 1 and type 2 diabetes mellitus. Whereas osteoporosis is more likely with type 1 diabetes, it does not appear to be strongly associated with type 2 diabetes. The reasons for this may be linked to the difference in disease mechanism. However, type 2 diabetics are not entirely in the clear – poor management of diabetes can increase the risk of fractures.

Osteoporosis in Type 1 Diabetes

In type 1 diabetes, insulin is deficient. It is known that bone tissue has insulin receptors. Therefore it is sensitive to insulin. It is believed that bone resorption is normal in type 2 diabetes therefore the problem may lie with slower than normal bone deposition. Since the balance shifts with there being greater resorption, the bones become weak and prone to easy fractures.

The most prominent effects of osteoporosis are seen in the senior years. Type 1 diabetes starts in childhood or early adulthood and the effect of diabetes on the bone occurs for long periods of time. This has been substantiated by the greater risk of fractures in postmenopausal women with type 1 diabetes compared to postmenopausal women without diabetes.

Osteoporosis in Type 2 Diabetes

With type 2 diabetes, the effect on bone mass may be the opposite. It has been noted that bone mass is normal in type 2 diabetics which may be due to several possible reasons. Firstly, type 2 diabetics are often obese and this increases weight on the bones. This is increases bone strength which is proportional to the amount of force placed on it – whether due to muscle action or a heavier body weight.

Secondly, insulin levels are often higher than normal as type 2 diabetics are insulin resistant. It appears that bone tissue may not be as resistant to insulin as is the case with other tissues. Therefore the higher insulin levels maintains bone mass despite advancing age. This may also be more significant in women since insulin resistance and obesity in females contributes to higher male sex hormone (androgen) levels – another contributor to strong bones.

Fracture Risk in Diabetics

Type 1 diabetics are at a greater risk of fractures, particularly with the elderly and postmenopausal women. Therefore greater care has to be taken with regards to supplementation and lifestyle measures. One would think that type 2 diabetics are less likely to experience fractures due to the somewhat “beneficial” effects of type 2 diabetes mellitus. However, this is not true.

In fact type 2 diabetics with poor glucose control will have complications such as nerve damage and impaired vision. This increases the chance of falls which ultimately can contribute to fractures. On the other hand, type 2 diabetics with good glucose control are at no greater risk of developing fractures that a person with diabetes. Therefore no additional measures are needed for osteoporosis prevention above and beyond what is the norm for the specific age group.


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