Article highlights
- Learn why diabetes can increase your risk of bone loss and fractures.
- Understand why bone density doesn’t tell the whole story.
- Discover how falls, neuropathy and low blood sugar can affect fracture risk.
- Find out how calcium, vitamin D and exercise support stronger bones.
- Learn when to talk to your healthcare team about your bone health.
Are bone issues common in people with diabetes?
People with diabetes have a higher risk of bone issues than people who don’t have the disease. Common bone issues include arthritis, osteoporosis and hip fractures, as well as a condition known as “Charcot joint” or “Charcot foot.”
People with diabetes may have an increased risk of fractures even when their bone mineral density is normal. Bone strength depends on more than bone density alone. Read on to learn more about diabetes and bones.
What contributes to bone disorders?
If you have diabetes, you may have an increased risk of bone and joint disorders. Certain factors, such as high blood sugar levels, arterial disease, nerve damage (neuropathy), heart disease and obesity may contribute to bone issues. However, researchers aren’t sure if there are other factors that cause people with diabetes to have a higher risk of bone issues.
Diabetes can also increase the risk of falls, which can lead to fractures. Nerve damage, vision problems, low blood sugar, balance problems and muscle weakness may all contribute to falls.
What bone and joint problems are associated with diabetes?
- Osteoarthritis, a condition that happens when the protective cartilage that cushions the ends of your bones wears down over time.
- Osteoporosis, a condition that causes a loss of bone density and weakening of bone tissue. People with type 1 diabetes have been found to have a lower bone mineral density and a higher incidence of osteoporosis. People with type 2 diabetes have a higher bone mineral density, yet they have a higher risk of fractures. It is not known why type 2 diabetes affects bone strength regardless of the bone mineral density.
- Bone fractures, especially hip fractures, are common in people who have either osteoarthritis or osteoporosis. A recent study found that people with diabetes have a higher risk of hip fractures than those who don’t have the disease.
- Charcot joint, a rare but serious condition in people with diabetes who have neuropathy. It initially causes redness, swelling and feels warm to the touch. Eventually, it can lead to weakness or breaks in the bones and dislocation of the joints of the foot and ankle. If you have diabetes and neuropathy, new redness, warmth, swelling or a change in the shape of your foot should be assessed by a healthcare professional promptly. Early treatment can help prevent further damage.
Does having diabetes mean you need a bone density test?
Not everyone with diabetes needs a bone mineral density (BMD) test. Your healthcare provider can assess your risk of osteoporosis and fractures based on factors such as your age, diabetes type and duration, previous fractures, family history, medications and other health conditions.
If you have concerns about your bone health or your risk of fractures, ask your healthcare provider whether a BMD test or other fracture-risk assessment is appropriate for you.
What can be done to reduce the risk of bone disease?
There are several things you can do to support healthy bones and reduce your risk of fractures. Regular physical activity, adequate calcium and vitamin D, maintaining muscle strength and reducing your risk of falls all play a role in bone health. The four main things you can do are:
1. Control your blood sugar by meeting the targets set by your diabetes healthcare team. Managing your blood sugar is an important part of overall diabetes health, but bone health also depends on factors such as physical activity, nutrition, muscle strength, fall risk and other health conditions.
2. Ensure you get enough bone-healthy vitamins and minerals. Calcium and Vitamin D are essential nutrients for proper bone health. Vitamin D helps to increase the absorption of calcium, ultimately building stronger bones. It also improves the function of muscles, improving your balance and decreasing the likelihood of falls, which can lead to fractures. The best way to add calcium to your diet is by eating low-fat dairy products, dark green leafy vegetables and calcium-fortified products. It is often difficult to get enough vitamin D through diet, so often a supplement is required.
Your calcium needs depend on your age and other individual factors. Whenever possible, aim to meet your calcium needs through food, and ask your healthcare provider whether you need a vitamin D supplement.
3. Exercise regularly. The benefits of exercise, especially weight-bearing and resistance exercise include not only stronger bones, but weight loss, decreased risk of heart disease, and increased energy levels. Regular exercise also improves your body’s sensitivity to insulin and helps manage your blood sugar levels. Balance exercises are also important because they can help reduce the risk of falls. Strengthening your muscles can support balance, mobility and overall bone health. If you have neuropathy or overweight, talk to your healthcare team about exercises that are appropriate for you.
4. Taking your medication exactly as prescribed can help you manage your blood sugar and reduce the risk of diabetes-related complications. Delaying or skipping medication doses altogether can increase your risk of hyperglycemia and other complications of diabetes. Some medications and health conditions can also affect bone health or fall risk, so talk to your healthcare team about your individual risk.
What else can you do to protect your bones?
In addition to regular exercise and getting enough calcium and vitamin D, there are other ways to support bone health. Avoid smoking and limit alcohol, as both can increase fracture risk. Eating enough protein can help maintain muscle strength, which is important for balance and mobility.
You can also reduce your risk of falls by having your vision checked regularly, keeping walkways free of hazards and talking to your healthcare team if you experience dizziness, balance problems or frequent episodes of low blood sugar.
3-Step Action Plan: Protect Your Bones
1. Know your risk
Ask your healthcare team whether you should have a bone-health or fracture-risk assessment.
2. Strengthen your bones and muscles
Include weight-bearing, resistance and balance exercises regularly.
3. Support bone health daily
Get enough calcium and vitamin D and take steps to prevent falls.
When should you talk to your healthcare provider about your bone health?
Talk to your healthcare provider if you have had a fracture from a minor fall or injury, have had repeated falls, notice a loss of height or new back pain, or have concerns about osteoporosis. If you have diabetes and neuropathy, seek medical attention promptly if you notice new redness, warmth, swelling or a change in the shape of your foot.
Your healthcare provider can help assess your individual risk and determine whether you need further testing or treatment.
