What is Diabetes?
Diabetes is a prevalent disease affecting more than 29 million people in the United States and 382 million worldwide. It impacts your body’s ability to use glucose (sugar) as a fuel for energy and growth. Normally, food is digested and glucose is absorbed into your bloodstream. Glucose then enters your cells by using insulin, which acts as a “key” to unlock the door. Those suffering from diabetes have a disruption in this process.
- Type I Diabetes: the pancreas stops producing insulin (your body lacks the “key” to open the door for glucose to enter your body’s cells to be used for energy).
- Type II Diabetes: your body’s cells stop responding to insulin (your body “changed the locks” so that the insulin “key” no longer fits).
How is Diabetes Diagnosed?
If you have diabetes, you may experience common symptoms including increased hunger (polyphagia), thirst (polydipsia), and frequent urination (polyuria). Over time, you may also experience slow healing cuts or wounds, nerve damage (neuropathy), blurred vision, and extreme fatigue.
To diagnose diabetes, we use either your fasting blood glucose, or hemoglobin A1C labs.
- Hemoglobin A1C: This lab measures your average blood sugars over a 2-3 month period of time. If your A1C number is ≥ 6.5%, this indicates chronically elevated blood sugar levels and is considered to be positive for diabetes.
- Fasting Blood Glucose: This lab measures your current blood sugars on an empty stomach. If your fasting glucose number is ≥ 126 mg/dL on at least 2 occasions, this is considered to be positive for diabetes.
How Does Diabetes Impact Your Bones?
Diabetes has been shown to directly weaken your bones. Those with type I diabetes have a 12-fold greater risk of sustaining an osteoporosis-related fracture compared to the general population, whereas those with type II diabetes have a more mildly increased fracture risk.
Do not let your bone density measurement lull you into a false sense of security if your T-score comes back “normal” or “osteopenia.” Studies have indicated that diabetes may only slightly decrease bone density in those with Type I diabetes, and those with Type II diabetes may even have INCREASED bone density compared to the general population. Despite this seemingly normal, or only slightly reduced bone density, diabetes has been shown to weaken bones and cause fractures. The true cause is not fully understood, but the following factors certainly contribute to this phenomenon.
- Elevated blood sugars levels have been shown to be toxic to bone-building osteoblast cells, leading to less new bone formation.
- Advanced glycation end products (AGEs) can accumulate in those with diabetes. AGEs are an osteoporosis double-whammy… they slow down the rate that osteoblast cells can build new bone, and increase the rate at which osteoclasts break down bone.
Aside from directly weakening your bones, complications from longstanding diabetes can also increase your likelihood for breaking bones. High blood sugar levels cause damage to your nerves and blood vessels, leading to vision loss, poor balance, and decreased exercise tolerance. All of these have been associated with falls, and as you know, falls increase your risk of breaking bones.
A class of medications used to treat type II diabetes has also been linked to osteoporosis. Thiazolidinediones (Avandia, Actos) are used to increase the effectiveness of the insulin “key” opening the door to let sugar into your cells. Several studies have shown these medications decrease the bone building effects of osteoblast cells, and lead to a 1.5-fold increase in your fracture risk.
How Can Those With Diabetes Improve Their Bone Health?
If you have diabetes, you can decrease your risk of breaking bones by closely monitoring and controlling your blood sugar levels. Should you need an osteoporosis medication, current medication options are equally as effective in people with and without diabetes.