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Diabetes Mellitus and Bone Health

Diabetes mellitus as we all know is highly prevalent and leads to multiple complications in various systems of our body including heart, kidney, eye and nerves due to its microvascular and macrovascular pathogenesis. The average age at which diabetes is diagnosed is steadily declining with more middle-aged person getting affected. Bone is a dynamic structure with continuous cycles of formation and resorption which is modulated by hormones and metabolic factors. Since diabetes is basically an endocrine hormonal disorder, it obviously can result in alteration of skeletal metabolism and hence resultant bony disorders.

Diabetes mellitus and bone health

The changes in bone due to type 1 and type 2 diabetes are due to different mechanisms regarding bone strength, bone turnover, and stem cell differentiation that result in altered bone mineral density (BMD) and bone structure. The development of bone forming cells (osteoblasts) is affected in both types, leading to the formation of adipocytes (fat forming cells) which results in poor quality bone formation. Because of these factors, the following changes can happen in the bones: increased fracture risk, delayed union and non-union of fractures, osteoporosis and higher chance of infection.

Are all diabetic patients prone to bony ailments?

No. Since the mechanism of tissue damage in diabetes is extensively studied and understood, various methods including lifestyle changes, regular physical activity, proper glycemic control and periodic check-ups prevent many complications as well as aids in early alleviation of established issues.

What precautions or steps should be followed to maintain healthy bones in diabetes mellitus?

  • Healthy lifestyle
  • Prevention of diabetic complications
  • Avoid thiazolidinediones
  • Glycemic control
  • Osteoporosis therapy
  • Calcium and vitamin D supplementation
  • Assess and prevent falls

Can diabetic neuropathy affect bones?

It can directly as well as indirectly affect the bone. Direct causes being altered bone mineral density, poor healing of microfractures due to minor trauma and fatty marrow replacement, the indirect causes are falls due to derangement of proprioception (joint senses) and gait imbalance.

What tests should be done routinely in diabetic patients to diagnosis bone abnormalities?

In asymptomatic patients less than 50 years of age, no investigation is necessary.

Patients between 50 to 60 years of age with symptoms of generalized fatigue, multiple joint pain and fracture history, periodical DEXA scan and blood investigations to assess blood calcium, phosphorus and renal function should be done. However, women more than 60 years of age and men more than 70 should have bone mineral density evaluation to assess the osteoporosis status and need for osteoporotic medications.

Can anti-osteoporotic medication affect blood sugar level or anti-diabetic medicines?

Depending on the DEXA scan and symptoms, calcium supplementation along with weekly tablets (oral bisphosphonates), yearly injection (Zolendronate) or daily infection (Teriparatide) is prescribed to any patient with osteoporosis. None of these medicines have reported effects on diabetes and there is no established drug interaction with diabetic medicines. Hence patients on diabetic medicines can safely continue anti-osteoporosis treatment as per their treating doctorโ€™s advice.

Dr. P. Keerthivasan

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

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