Diabetes and Osteoporosis – A Recipe for Disaster

Awareness about diabetes mellitus is reasonably adequate owing to its high prevalence in this era and the complications associated with it. Many middle aged-people check their fasting and post-prandial blood sugar levels even without a doctor’s advice if they have giddiness or some related symptoms. Conversely, although osteoporosis is the most prevalent metabolic bone disorder, the awareness is meagre since it is usually asymptomatic until one gets a fracture. Recent research has shown a clear causal relationship between diabetes and osteoporosis. We may even soon hear the word “diabetic osteopathy!!!” like diabetic retinopathy and diabetic nephropathy.


How Are They Related?

Type I diabetes onset usually occurs at a younger age and since it affects the hormonal and metabolic systems, the formation and strengthening of the bone itself is affected and people with this condition are found to have a low Bone Mineral Density (BMD) from their younger days. Hence, the chances of fracture and associated complications are higher. Type II diabetes is associated with disorders of kidney and blood vessels which can indirectly weaken the bones through high calcium loss in urine and poor blood supply to the skeletal system.

Why Is This Combo Dangerous?

Peripheral neuropathy, which is very commonly noticed in type 2 diabetic patients leads to poor walking balance and frequent falls, and may lead to a morbid fracture if they are also osteoporotic. Both conditions cause early fatigue and, when left unchecked, can worsen because of reduced physical activity. The management of fractures in osteoporosis turns complex due to high chance of implant failure and non-union and that in diabetes due to higher risk of infection and wound healing issues. This complexity increases exponentially if they co-exist in a patient.

What Patients with a Diabetic Condition Should Do to Prevent Osteoporosis?

Like diabetes, osteoporosis also can’t be cured but can be kept under control.

Quit Smoking

Smoking aggravates both these conditions and accentuates the complication pathways.

Regular Physical Activity

Helps to control the blood sugar level as well as improves bone strength. What is walking for diabetes is resistance and weight-bearing exercise for osteoporosis. They include weight lifting, stair-climbing and dancing which will strengthen the entire musculoskeletal system and reduce the fall and fracture risk.

Proper Diet

Diet rich in calcium and vitamin-D.


If you are already diagnosed with osteopenia or are a post-menopausal woman, it is essential to take daily calcium supplements by means of tablet or powder and weekly boosters of vitamin D for 8-12 weeks in a year.

Regular Medical Check-Ups

Early detection of osteoporosis is vital as early treatment gives better results. BMD (DEXA) scan should be done periodically (once in three years) to detect and monitor the progress of osteoporosis.


It depends on the BMD value and the medicines available currently are proven to reduce the fracture risk by more than 70%. So, it is wise to follow the doctor’s prescription for osteoporosis treatment even if it involves daily injections.


Dr. P. Keerthivasan
Consultant Orthopaedic Spine Surgeon
Kauvery Hospital Chennai