The physiological impact of type 2 diabetes, a chronic metabolic dysfunctioning resulting in persistent hyperglycemic state, is well known and directly impacts the vital organs of the body such as eyes, heart, kidneys etc. But latest studies have shown the effect of this ‘silent epidemic’ even on the body’s musculoskeletal system. Type 2 diabetics are at a heightened risk of osteoporosis, osteoarthritis and fractures. For a better understanding on why maintaining bone health is crucial for diabetics, we spoke to Dr Pulak Vatsya, Consultant Sports Orthopedics and Robotic Joint Replacement and Ex- Senior Resident AIIMS, New Delhi.
Connection Between Diabetes and Bone Health
This metabolic condition directly affects the bones by reducing its density as well as quality.
"In the individuals suffering from type 1 diabetes, there is a significant impact on the bone mass formation and as this condition is more prevalent in children and adolescents, it seriously affects the bone formation in the early years of life. This raises their risk of getting fractures by 6 to 12 times. Also fractures take much longer to heal and if any surgery is required, there is a high chance of getting infected," explains Dr Vatsya.
In the individuals living with type 2 diabetes, the bone density increases, but the bones are of poor quality and very prone to getting broken. Diabetes raises their risk of fracture at least 1.3 times.
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Mechanisms affecting bone health in diabetics
- Hyperglycemia - When the blood glucose levels remain persistently high in the body, the collagen present in the connective tissues get glycated (the sugar molecules bind with the proteins and affect the structural matrix). This makes the bone much more brittle and prone to fractures.
- Insulin resistance - Insulin, the hormone secreted by pancreas, is needed for the activity of osteoblasts that aid in bone formation. But in diabetes, there occurs insulin resistance and this activity gets impaired and this weakens the bones.
- Inflammation - Diabetes is a metabolic disorder that is linked with inflammation which directly affects the bone remodelling process. The pro-inflammatory cytokines rise in diabetics (namely interleukin-6 and TNF-alpha) which weaken the bone over time.
- Diabetic neuropathy - This condition causes weakening of the nerves and results in loss of sensation, causing frequent falls. These frequent falls and added weakened bones lead to easy fractures.
How To manage bone health in diabetics
- Routine screening of bones - Those individuals who have long-standing diabetes or uncontrolled blood glucose levels should get themselves regularly screened for osteoporosis, which can be done by routinely DXA (dual-energy X-ray absorptiometry) scan.
- Diet rich in calcium and vitamin D - For healthy bones, you need calcium rich foods such as dairy products (milk, curd, cheese etc.) and for the better absorption of calcium, vitamin D is required. For getting the adequate dose of vitamin D, consume vitamin D fortified foods, fatty fish, egg yolk or supplements.
- Weight-bearing exercises - For strengthening the bones and reducing the risk of frequent falls, diabetics should regularly engage in weight-bearing exercises such as jogging, walking, strength training etc. Also, another added advantage of exercise is insulin sensitisation that improves the glycemic control.
- Glycemic control - Most of the musculoskeletal issues in diabetics arise from poor glycemic control. So diabetics should be mindful about this and regularly engage in physical activity, consume a wholesome diet and take their oral hypoglycemic drugs (OHAs) on time as per the doctor’s prescription.
Bottom line
Musculoskeletal impact of poor glycemic control in diabetics is often an overlooked aspect but needs urgent attention. For protecting the bones, diabetics should be proactive and keep their bones regularly screened, follow a bone health boosting diet and perform regular exercises.