Diabetes and Bone Health: Risk Factors and Prevention
Mar 14, 2022, 13:28 PM
By Chauntae Reynolds, PharmD, BCACP, CDCES
When you think about diabetes complications, what initially comes to mind: Kidney disease? Cardiovascular disease? Hypoglycemia?
A common, but not often discussed diabetes complication is osteoporosis. Osteoporosis is a bone disease characterized by weakening of bone tissue, bone structure, and bone strength, and may lead to increased risk of fractures. Osteoporosis is diagnosed by measuring bone mineral density (BMD) via dual-energy x-ray absorptiometry (DXA). In the United States, over 10 million people age 50 and older have osteoporosis, with women being the majority of this population. More than 43 million people in the United States have low bone mass, or osteopenia, which puts them at increased risk of developing osteoporosis. Fractures can significantly impair mobility, limit independent living or even cause death.
Older adults with both type 1 and type 2 diabetes are at a higher risk of fractures than people without diabetes, even if they have a normal bone mineral density. This increased risk is still being studied but may be due to age of diabetes diagnosis, diminished bone healing after falls and/or certain diabetes medications.
Other risk factors for osteoporosis include:
- Over age 50.
- White or Asian descent.
- Family history of osteoporosis.
- Low body weight (<127lbs).
- Certain medications, including long-term steroid use.
As diabetes care and education specialists, it is important that we identify high-risk patients and recommend screening for osteoporosis. The US Preventative Services Task Force (USPSTF) recommends women age 65 and older obtain a DXA screening for osteoporosis. High-risk post-menopausal women under age 65 may also qualify for screening.
In addition, diabetes complications such as retinopathy, neuropathy, and hypoglycemia can increase the risk of falls and fractures. Diabetes care and education specialists are in a unique position to counsel high-risk patients on lifestyle and dietary changes to reduce the likelihood of falls and fractures, such as:
- Smoking cessation.
- Avoid excessive alcohol.
- Weight-bearing and muscle-strengthening exercises.
- Reduce fall risk by removing loose rugs, securing electrical cords, and installing grab bars.
- Ensure adequate calcium (1200mg per day) and vitamin D intake (800 to 1000 IU, or 20 to 25mcg per day).
To learn more about the risk of complications for people with diabetes, visit DiabetesEducator.org/Coconditions
ADCES Perspectives on Diabetes Care
The Association of Diabetes Care & Education Specialists Perspectives on Diabetes Care covers diabetes, prediabetes and other cardiometabolic conditions. Not all views expressed reflect the official position of the Association of Diabetes Care & Education Specialists.
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