eight loss can be from a variety of causes including loss of fluid in the discs of the spine, flattened arches in the feet, poor posture, and vertebral (spine) fractures. It is estimated that about two-thirds of vertebral fractures are silent; unknown to the individual unless an x-ray is performed. So, why worry? Because having a vertebral fracture has many negative consequences including rounded shoulders and spine, impaired breathing, difficulty with digestion/early satiety, a thick waistline, a change in how clothes look and fit, poor self-esteem, pain, an increased risk of falls, and increased risk of another osteoporotic fracture.
It is relatively easy to detect vertebral fractures, starting with a measurement of current standing height and comparing it to maximal recalled height to determine historical height loss (HHL).
HHL = tallest recalled height - current measured height
Studies show that if loss of height from the maximal recalled height is greater than about 1 1/2 inches, there is an increased chance of a vertebral fracture. If HHL is between about 2 1/2 and 3 inches, there is an even greater chance of vertebral fracture and, if HHL is greater than 3 inches, there is a very high likelihood of vertebral fracture. It is suggested that a person with HHL greater than 2 1/2 inches should have an x-ray of the spine to determine if there are vertebral fractures.
A person with diabetes may also have an increased risk of falls due to visual problems, neuropathy, pain, or decreased activity levels.
What does this have to do with diabetes? We have known for a long time that having type 1 diabetes can increase the risk of osteoporosis and fracture, likely due to a change in the quantity and quality of bone. There is also an increased risk of fractures in those with type 2 diabetes, in spite of average or better than average bone density, likely due to problems with quality of bone. A person with diabetes may also have an increased risk of falls due to visual problems, neuropathy, pain, or decreased activity levels. Many fractures, including hip fractures, are the direct result of a fall.
One way to prevent future fractures is to determine if an individual has, or is at increased risk of, osteoporosis and fracture. Consider performing an annual height assessment along with other vitals. A quick and accurate measurement can be performed at the time of the weight measurement during an office visit. If a person with diabetes is determined to have osteoporosis and/or fracture, steps can be taken to decrease the risk of future fractures including:
- Getting optimal nutrition including adequate calcium and vitamin D
- Having a medical evaluation for osteoporosis and fracture risk
- Improving balance and decreasing the risk of falls
- Performing bone healthy exercises
- Smoking cessation
- Limiting alcohol intake
- Discussing osteoporotic medications with a healthcare provider and initiating if indicated
As diabetes educators, we can facilitate annual height measurements and further testing as needed to identify those who have had a silent fracture and are at increased risk of future fractures.
About the Author
Karen Kemmis is a physical therapist, exercise physiologist, certified diabetes educator, and also holds certifications in Pilates for rehabilitation and exercise for aging adults. She is based out of SUNY Upstate Medical University in Syracuse, NY and splits her time between a Joslin Diabetes Center affiliate, an outpatient rehabilitation department, and a PT program where she is an adjunct professor.