The role of diabetes
Numerous explanations have been suggested for the effect of diabetes on BMD and risk of fracture, but so far, most are not backed up by conclusive research. They include hormonal factors such as higher insulin levels, diabetic complications, and a higher rate of falls. In most studies of both Type 1 and Type 2 diabetes, level of blood glucose control has not been associated with BMD or risk of fracture, but more research is needed to confirm this finding.
One possibility currently under investigation is whether advanced glycation end-products (AGEs), substances that are formed when glucose reacts with proteins inside a cell, accumulate in bone tissue and weaken it. New evidence is also emerging that connects BMD to some conditions that commonly arise from diabetic complications: Very recent studies suggest that reductions in nerve, kidney, and cardiovascular function are related to lower BMD, bone loss, and fracture among older adults, whether or not they have diabetes. Furthermore, several studies of people with Type 1 diabetes have demonstrated that lower BMD is associated with neuropathy (nerve damage), retinopathy (an eye disease), and nephropathy (diabetic kidney disease). More research on diabetic complications is needed to better understand their impact on BMD and fracture risk.
Ensuring bone health
It is critical for people at high risk for osteoporosis to get screened for it so that fractures can be prevented. The major factors that increase the risk of osteoporosis are the following:
- Older age
- Female sex (especially at the time of or after menopause)
- History of fractures as an adult
- History of osteoporosis or fractures in a parent or sibling
- Low body weight (less than about 127 pounds)
- Smoking
Additional factors that may increase the risk of osteoporosis include the following:
- Low calcium or vitamin D intake, especially lifelong
- High alcohol intake (more than two drinks per day)
- Lack of exercise
- Estrogen deficiency in women, especially at an early age
- Some medicines for thyroid conditions
- Use of corticosteroids or immunosuppressive drugs (for asthma, arthritis, cancer, or transplant surgery)
- A variety of other medical conditions including chronic intestinal disorders, nutritional disorders, endocrine disorders, stroke, kidney failure, and organ transplantation
If any of these factors apply to you, you may want to discuss having a bone density test with your health-care provider. In general, the more of these factors you have, the greater your risk of osteoporosis and fracture.
Several steps can be taken to prevent or treat low BMD. These include eating calcium-rich foods or taking calcium supplements (1,000—1,500 milligrams per day), ensuring adequate vitamin D intake (400—1,000 IU per day), not smoking, not consuming alcohol in excess, and exercising regularly (especially weight-bearing activities such as walking, jogging, stair climbing, and weight training). If you choose to take calcium supplements, take no more than 500 milligrams at a time because your body can’t absorb more than that at once. If you already have osteoporosis, you may want to discuss the variety of drug treatment options available with your doctor.
