Read on as we explore some of the links between diabetes and osteoporosis.
Diabetes, scientifically known as diabetes mellitus, is a chronic, metabolic disorder. Diabetes occurs when the body doesn’t produce enough of the hormone insulin, or the insulin produced isn’t effective.
Normally, when carbohydrates are broken down into glucose in the digestive system, insulin helps transport the glucose from the blood to cells around the body. Without insulin, glucose will remain in the bloodstream causing blood sugar levels to rise.
New figures show 4.3 million people are now living with diabetes in the UK, with a further 850,000 people yet to be diagnosed.
There are 2 main types of diabetes:
Type 1 diabetes causes the body’s immune system to attack and destroy the cells in the pancreas required to make insulin. Without insulin, the glucose will remain in the bloodstream, causing blood sugar levels to rise.
Predisposing factors for type 1 diabetes include:
The UK has one of the highest rates of type 1 diabetes in the world (Juvenile Diabetes Research Foundation). There are approximately 400,000 people living with type 1 diabetes in the UK, with cases increasing by 4% every year.
Type 2 diabetes occurs when the body does not produce enough insulin to regulate glucose levels, or the body’s cells do not react efficiently to insulin.
Around 90% of diabetic adults in the UK have type 2, making it much more common than type 1.
Predisposing factors for type 2 diabetes include:
Diabetes is commonly associated with many health conditions, such as increased risk of heart attack, stroke, kidney failure and vision problems. However, many people don’t realise the impact diabetes may have on their bone health.
Osteoporosis and other bone-related diseases are often underestimated complications of diabetes. Here’s a look at what diabetes is doing to impact bone health:
Our bones are constantly regenerating through the process of bone remodeling. During this process, osteoclasts break down old bone, and osteoblasts form new bone.
Type 1 diabetes results in an imbalanced bone remodeling process, typically from an early age. This causes osteoclasts break down old bone quicker, and osteoblasts form new bone slower than they should. The result is lower peak bone mass and a greater risk of developing osteoporosis in later life.¹ It’s important to note, the mechanisms underlying bone fragility are not completely understood.
Similarly, type 2 diabetes impairs the bone remodelling process, causing a reduction in bone mass and strength.
People with type 1 and type 2 diabetes usually have lower levels of vitamin D.² Since vitamin D plays an important role in calcium absorption, lower levels may increase your risk of developing osteoporosis.
Thiazolidinediones, a class of antidiabetic drugs, have been shown to be a cause of secondary osteoporosis and increased fracture risk.³ By disrupting the bone remodeling process, these drugs can cause a further reduction in bone mass.
Diabetic patients have an increased risk of sustaining a fracture. Those with type 1 diabetes are six times as likely to break a bone compared to the general population, due to their low bone mass and density. Patients with type 2 diabetes are twice as likely to sustain a fracture compared to people without diabetes.⁴
Bone healing may be impaired too, resulting in longer recovery times for individuals with both diabetes and osteoporosis.
While diabetes increases the likelihood of osteoporosis, it does not mean it’s inevitable.
Fortunately, many things diabetics do to manage their condition may also reduce their risk of developing osteoporosis.
Regular exercise and a balanced diet are beneficial for everyone tp help control blood sugar levels, as well as improve bone health. The NHS recommends adults consume 700mg of calcium and 10µg of vitamin D per day for healthy bones.
Avoiding smoking and reducing alcohol consumption will further decrease osteoporosis risk, while simultaneously helping to maintain healthy blood sugar levels.
If you are concerned about your bone health, make sure to talk to your GP or doctor who may refer you for a DEXA scan to assess your bone health.
1. Brunetti, Giacomina et al. “Mechanisms of altered bone remodeling in children with type 1 diabetes.” World journal of diabetes vol. 12,7 (2021): 997-1009. doi:10.4239/wjd.v12.i7.997
2. Michael J. Berridge; Vitamin D deficiency and diabetes. Biochem J 15 April 2017; 474 (8): 1321–1332. doi: https://doi.org/10.1042/BCJ20170042
3. Lecka-Czernik, Beata. “Bone loss in diabetes: use of antidiabetic thiazolidinediones and secondary osteoporosis.” Current osteoporosis reports vol. 8,4 (2010): 178-84. doi:10.1007/s11914-010-0027-y
4. Jackuliak, Peter, and Juraj Payer. “Osteoporosis, fractures, and diabetes.” International journal of endocrinology vol. 2014 (2014): 820615. doi:10.1155/2014/820615