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What Is the Connection Between Diabetes and Bone Health?

For African Americans, diabetes is a serious health concern, affecting 12.7% of the population[1]. Most people recognize the complications of diabetes, such as heart disease, stroke, neuropathy, and eye problems, but did you know that people with diabetes are at an increased risk of breaking a bone? In 2017, Jennifer Walsh published an article looking at type 2 diabetes and bone in adults. [2]

People with Type 2 diabetes typically have higher bone density, due to increased body weight, so they may not get diagnosed with osteoporosis or low bone density that would trigger steps to prevent fractures and reduce the chance of fractures. However, there is a 1–2 times greater chance of fractures for people with diabetes[3].

What accounts for this increase in risk of fracture is still being studied, but there is emerging evidence that the excess sugar in the bloodstream attaches to the collagen the bone. The reason this is important is that the collagen in the bone makes the bone tougher and less likely to break when it has a force put on it, like a fall. When the sugar attaches to the collagen, it creates structural changes that make the bone less flexible and more brittle.[4],[5]

Researchers who have looked at the properties of bone in people with type 2 diabetes have found that the strength of the bone in these patients is 10% less than is patients without type 2 diabetes.[6]

There is also some evidence that treatments for diabetes, such as Metformin, can reduce the risk of fracture, while others like TZDs and glitazones, actually increase the risk of fracture.[7]

The bottom line is that people with type 2 diabetes need to be concerned about their bone health. Steps to take: 1) work to control blood sugar, 2) improve strength and balance to prevent falls, and 3) talk to a health care provider about fracture risk and whether you should take a medication to reduce your fracture risk.

[1] Centers for Disease Control and Prevention. National Diabetes Statistics Report, 2017. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services; 2017.

[2] Walsh, J.S. & Vilaca, T. Calcif Tissue Int (2017) 100: 528. https://doi.org/10.1007/s00223-016-0229-0

[3] Vestergaard P (2007) Discrepancies in bone mineral density and fracture risk in patients with type 1 and type 2 diabetes—a meta-analysis. Osteoporosis Int 18(4):427–444. doi: 10.1007/s00198-006-0253-4

[4] Saito M, Fujii K, Mori Y, Marumo K (2006) Role of collagen enzymatic and glycation induced cross-links as a determinant of bone quality in spontaneously diabetic WBN/Kob rats. Osteoporos Int 17(10):1514–1523. doi: 10.1007/s00198-006-0155-5

[5] Avery NC, Bailey AJ (2006) The effects of the Maillard reaction on the physical properties and cell interactions of collagen. Pathol Biol (Paris) 54(7):387–395. doi: 10.1016/j.patbio.2006.07.005

[6] Farr JN, Khosla S (2016) Determinants of bone strength and quality in diabetes mellitus in humans. Bone 82:28–34. doi: 10.1016/j.bone.2015.07.027

[7] Kahn SE, Zinman B, Lachin JM, Haffner SM, Herman WH, Holman RR, Kravitz BG, Yu D, Heise MA, Aftring RP, Viberti G, Diabetes Outcome Progression Trial Study Group (2008) Rosiglitazone-associated fractures in type 2 diabetes: an analysis from a diabetes outcome progression trial (ADOPT). Diabetes Care 31(5):845–851. doi: 10.2337/dc07-2270


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What to know about bone health
and fracture prevention during COVID-19

  • Remove fall dangers in your home.
  • Stay physically active, and at least 6 feet away from others.
  • Eat for proper nutrition, and take a supplement if needed to get enough calcium and vitamin D.
  • Stick with your osteoporosis medicines and ask your doctor for extra if you’re unable to go to the pharmacy.
  • If you are due for Reclast, there is little concern about delaying for a few weeks or months.
  • If you take Prolia or Evenity injections, don’t miss your appointment.  Some facilities offer “drive-through” injections. Check with your doctor.
  • Bone density testing can be postponed, if necessary.
  • Speak with your doctor about the possibility of telephone and video visits.

The Centers for Disease Control and Prevention has a page with steps you can take to reduce your risk of catching the virus if you have a chronic illness.

Be well. We are here for you if you have any questions.