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Bone health and diabetes: how are they related?

Bone health and diabetes: how are they related?

People with type 1 diabetes (T1D) are at a higher risk of suffering fractures and bone fractures.

Long associated with decreased bone mass in the elderly, people with T1D find themselves at greater risk of bone fractures and longer recovery times at a younger age than the general population. A study reported a sevenfold increased risk of hip fracture in people with T1D between the ages of 20 and 60.

As with any injury, diabetes can delay or disrupt healing with slow healing or complications. High blood sugar, or high blood sugar, is a common experience in diabetes that can interfere with bone formation and healing. There are a number of other conditions associated with diabetes that are also associated with a high risk of bone fractures. Not all of these relationships are fully understood.

Read on to learn more about why people with diabetes are at higher risk for fractures and what can be done about it.

Diabetes slows down the healing process. The immune system is disrupted, leaving people with diabetes vulnerable to infections and other potential complications. Healing of a bone fracture can be prolonged for up to 87 percent for people with diabetes, including a higher risk of healing complications.

A number of factors that are part of living with diabetes also involve higher risk broken bones.

  • Hypoglycemia. Also known as hypoglycemia, low blood sugar episodes are often accompanied by symptoms such as feeling faint, disoriented, and unsteady. Their falls resulting from vertigo can lead to bone fractures.
  • Hyperglycemia. In the long term, high blood sugar can contribute to bone fragility by producing more advanced glycation end products (AGEs). Accumulation of AGEs was observed with reduced bone formation in rats with hyperglycemia.
  • Complications of diabetes. People who suffer from diabetes-related complications are at higher risk of bone damage, including those with reduced vision (caused by a condition called retinopathy) and nerve damage (neuropathy) in the feet or legs, which makes it more difficult to manage potential fall hazards.
  • Medications. Diabetes medications can lead to a higher risk of bone fractures. Insulin, in particular, has this potential given its hypoglycemic effects that can lead to hypoglycemia. Anyone with T1D should take insulin manually to replace what their body does not produce naturally, and many people with type 2 diabetes (T2DM) also take insulin by injection, insulin pump or inhaled insulin. Other diabetes medications, such as those aimed at lowering blood pressure, can cause dizziness and increase the risk of bone damage.
  • Comorbidities. People with diabetes often live with other health problems, such as thyroid disease, celiac disease, and rheumatoid arthritis. These comorbidities have mechanisms linked to a higher risk of bone fractures.

The main impacts of diabetes complications on bone health are twofold:

  • disrupt physical stability and movement in a way that leads to an increased risk of falls
  • disrupt blood flow in a way that undermines the creation and maintenance of bone mass

The complications of diabetes most commonly associated with bone health are:


The reduced vision that accompanies retinopathy, which is when the blood vessels at the back of the eye are damaged, can lead to confusion and dizziness and a higher risk of falls and broken bones.

Also, the loss of sight can cause the person to feel less confident in their physical movements in general. In response, the person reduces movement and exercise, which weakens bones and muscles.

In a Korean study, a “significant” association was found between the presence of diabetic retinopathy and reduced bone mass density and increased presence of osteoporosis in women. This finding was important enough for the researchers to suggest that retinopathy could be considered a marker of reduced bone mass density. Interestingly, the same association was not observed in men.


Nerve damage caused by neuropathy Harms bone health in two ways: by causing more falls and by disrupting blood flow to the bones. With neuropathy, the ability to feel sensation in the extremities and physical coordination are disturbed. Together, these elements increase the risk of falls and fractures. Additionally, neuropathy can disrupt blood flow to the bones, interrupting bodily processes that build up and maintain bone mass, causing bones to weaken over time.


As kidney function deteriorates in nephropathy, the body’s ability to filter waste products from the blood and regulate hormones that control bodily functions decreases. Both of these effects disrupt the normal mechanisms that build and maintain bone mass and strength. Over time, the body’s ability to repair bone mass and tissue is undermined.

Although people with the two main types of diabetes have a higher overall risk for their bone health, important differences have been observed.

In people with T1D, the risk of fractures is higher at an earlier age. We think it’s because changes in their bone mass seem to occur at a young age. Insulin is a bone anabolic agent, meaning it helps build bone, and therefore insulin deficiency contributes to poor bone formation.

The increased risk to bone health for people with T2D is associated with how long they have been diagnosed and how much insulin they use. The longer they suffer from high blood sugar, the more likely they are to show signs of bone weakening.

For both types, hyperglycemia can contribute to bone fragility by producing more AGEs with oxidative stress. Both of these factors are associated with a reduced rate of bone formation.

Yes. Traumatic injuries, such as a broken bone, can lead to stress hyperglycemia. This effect may be present with or without diabetes. Because high blood sugar can prolong and impair recovery, blood sugar should be closely monitored and managed when recovering from a broken bone.

Most broken bones are immobilized with a cast or corset. This will limit your ability to move and use the broken part of your body.

Follow a doctor’s orders and take time to rest and heal. You will most likely be told to rest and avoid putting weight on or stressing the broken bone.

If there are any complicating symptoms (swelling, strange sensations such as warmth or numbness, bleeding, etc.), seek treatment immediately.

There are a number of things you can do to improve your bone health.

  • Manage your blood sugar. Chronic hyperglycemia or hypoglycemia compromises bone health and increases the risk of bone fractures. Strict blood sugar management minimizes their effect.
  • Exercise. With regular exercise (both aerobic and weight-bearing), you strengthen your bones and your circulation. This helps maintain bone mass and strength. Exercise can also improve your sense of balance, reducing the risk of falls.
  • While eating. Food choices are a big part of living with diabetes. A balanced meal plan can consist of a balanced mix of macronutrients, vitamins, and minerals and supports overall health and bodily processes that build and maintain bone and muscle strength. Calcium, magnesium and vitamins D and C are particularly important. When using nutritional supplements (such as calcium or vitamins), discuss with a doctor the appropriate amounts to take.

Bone health is another aspect of the body that can be affected by diabetes. This is due to medications, including insulin, as well as diabetes-related complications that lead to a higher risk. Many of the things suggested to keep bones healthy and strong dovetail easily with the things people with diabetes are already told to do to manage their overall health, including managing blood sugar, eating balanced meals, and eating healthy meals. regular exercise.