When you think diabetes, do you think osteoporosis or fracture? Maybe not. Unfortunately, there is an association between type 1 and 2 diabetes and fracture.
We have known for a long time that there is a relationship with type 1 diabetes and osteoporosis. Now, we also know there is an increased risk of fracture with type 2 diabetes, even with average or better than average bone density.
Osteoporosis, or porous bone, is a disease where the bone is not thick and/or strong enough leading to increased risk of fracture, especially in the hip, spine and wrist. It is estimated that 10 million people in the US have osteoporosis and another 43 million have low bone density putting them at risk for osteoporosis and fracture. About 1 in 2 women and 1 in 5 men will have a fracture related to osteoporosis! A fracture can cause many problems including risk of decreased mobility, admission to a nursing home, and even death.
There are some steps that can be taken to decrease the risk of osteoporosis, low bone density, and fracture. It is important to start early, during childhood and the teenage years, to build bone. During adulthood, we can work to modestly increase bone density and strength. Later in life, we can work to maintain density and strength but the main focus it to decrease the risk of falls to avoid a fracture.
Let’s look at the steps to protect bones with specifics for a person with diabetes (PWD):
• Do regular exercise/physical activity: This is important for all of us! The recommendations for exercise are basically the same to prevent osteoporosis and fracture and for a PWD. We should aim for about 30 minutes per day, most days of the week, of moderate exercise. To help build or maintain bone density, try for impact activities (brisk walking, hiking, stair-climbing, dancing, jogging or jumping rope). If a person has pain or other problems that would be increased with impact, try activities with less impact (elliptical, water exercise, bicycling). Strength training is also helpful for a PWD and to improve bone density. If a person hasn’t done strength training, it is best to work with a trainer who can help with best form for safe exercise.
• Eat healthy: A well-balanced diet will provide most of the important nutrients for bone health. This includes fruits and vegetables and healthy proteins (the building blocks for strong bones). When a PWD follows a healthy meal plan for diabetes, bones will be healthy, too!
• Get enough calcium and vitamin D: The recommended allowances vary by age. For vitamin D, children need 400 to 600 international units (IU) and adults need 600 to 800 IU per day. For calcium, children need from 200 to 1300 mg, increasing with age, and adults need 1000 to 1200 mg. It is good to have calcium-rich foods/beverage options with low, moderate, and high carbohydrate content to fit an individual’s diabetes meal plan. It is also helpful to know dairy-free and gluten-free options for individuals with lactose intolerance and gluten sensitivity or celiac disease. A PWD can work with a dietitian to include these nutrients in his/her meal plan.
• Limit alcohol: Generally, we should limit alcohol intake to 1-2 drinks per day. Taking in more can get in the way of healthy nutrition and increase the chance of a fall/fracture.
• Don’t smoke: Smoking is harmful to the bones and increases the risk of complications of diabetes. If a person does smoke, this is one more reason to stop. It is never too late!
• Don’t fall/work on balance: As the years go on, many people notice balance isn’t what it used to be. Many people don’t know they can improve balance but it can get better by doing challenging balance exercises. This has been proven specifically in people with diabetes. If a person has fallen in the last year or loses balance easily, she/he is at high risk of falls so should see a physical therapist (PT) or participate in a community balance program. Over 90% of hip fractures and nearly half of spine fractures are due to a fall; almost all fractures in the wrist, shoulder and pelvis are due to a fall. So, if a person doesn’t fall, the risk of fracture is greatly decreased! A PWD might have many risks for falls including vision problems, lack of sensory input from the feet due to neuropathy, taking more than 4 medications, and variable blood pressure to name a few. A complete balance assessment should be performed by a healthcare provider for a person at high risk of falls.
• Stand tall: Many spine fractures can be prevented by keeping the spine in a good position without forward flexing. This means using the legs to lift so the back can stay straight and avoiding flexing movements such abdominal curl sit ups and toe touches. If a person has slouched posture and struggles to be in a good position, he/she can work with a physical or occupational therapist to improve it.
Diabetes educators can raise awareness of the possibility of osteoporosis and fracture in a PWD and can help with steps to decrease this risk through adjustments to the diabetes self-management plan and referrals to specialists as needed.