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DIABETES
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10,000 Steps
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Canada Food Guide Revisited
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Childhood Diagnosis of Diabetes
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The Discovery of Insulin
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Managing Diabetes Magazine - diabetes

Stand Tall Against Osteoporosis
How diabetes affects your bone health

Adults are not meant to shrink as they get older. Although we may think of it as common, losing height is not a normal part of aging. Rather, it can signal osteoporosis – a disease where bones become fragile and break more easily. Having diabetes can increase the chance of suffering a broken bone due to osteoporosis. In learning how diabetes affects bone health, you can help keep your bones strong for a lifetime.

Table 2 Major risk factors for osteoporosis

  • Age 65 or older
  • History of a spine fracture
  • History of low trauma fracture after age 40
  • Having a family member with a fracture caused by osteoporosis, especially a mother with a
    hip fracture
  • Taking glucocorticoid medicine (such as prednisone) for more than three months
  • Medical conditions that limit absorption of nutrients, such as celiac disease or Crohn’s disease
  • Overactive parathyroid gland
  • Tendency to fall
  • Osteopenia (thin bones) found on x-ray
  • Low testosterone (a male hormone) in men
  • Loss of menstruation in younger women
  • Early menopause (when periods stop before age 45) in women

Osteoporosis – the silent thief

With osteoporosis, bone wears away slowly in a process called bone loss. There are no noticeable symptoms. In fact, osteoporosis is often referred to as the silent thief. Over time, bones become less dense – thinner, lighter and weaker. Eventually, they become fragile.

Real problems start when fragile bones fracture or break with very little force. These fragility or low trauma fractures happen most often in the wrist, hip and spine. The end result may be long-lasting pain, change in body shape, and lessened or lost mobility and independence. Osteoporosis can be devastating.

This very common condition is estimated to affect 1.4 million Canadians. One in four women and one in eight men over the age of 50 have osteoporosis. Younger people may be affected as well. Costs related to treating osteoporosis and fractures reach nearly two billion dollars a year in Canada. These statistics are alarming. Costs will only continue to rise as the number of older people in the population increases.
Bone is living tissue, constantly being formed and broken down in a process called remodelling. When it breaks down faster than it forms, bone loss occurs. Bone building happens all through childhood and adolescence, until peak bone density is reached in the twenties. Good nutrition and lots of physical activity during this time make bones strong. Peak bone mass is maintained until the thirties, then slowly drops as we age.

Table 3 Minor risk factors for osteoporosis

  • Rheumatoid arthritis
  • Overactive thyroid gland
  • Taking anti-seizure medicines
  • Using heparin (a blood thinning medicine) long-term
  • Body weight less than 57 kilograms (125 pounds)
  • Low calcium intake
  • Excess caffeine (more than four cups of coffee, tea or soda per day)
  • Excess alcohol (more than two drinks per day)
  • Smoking

A link between diabetes and osteoporosis

Diabetes seems to affect bone health. Men and women with diabetes have a higher risk of fracturing a hip than those without it. A recent review found that having type 2 diabetes significantly increases the risk of hip fracture. With type 1 diabetes, the risk increases about six times. We do not know exactly why.
Type 1 diabetes is often diagnosed in childhood or adolescence, both important times for bone development. The condition seems to keep bones from reaching maximum density and strength. Lower bone density may be related to longer duration of type 1 diabetes. Lack of insulin could be responsible, but other theories have been suggested.

In general, carrying excess body weight is linked to higher bone density. Those with type 2 diabetes often carry more weight and so should have stronger bones and fewer fractures. However, this is not the case.

Although bone density may be higher, bone quality may also be poor. Bones are more breakable. Research suggests that poorly controlled blood glucose levels can lead to greater bone loss.

Perhaps the higher fracture risk with diabetes is due to a greater chance of falling. Falls cause fractures. Complications of diabetes, such as vision prob lems and nerve damage, can cause falls. Falls can also happen during hypoglycemia or reactions to low blood glucose.

Table 1 Recommended Daily Intakes
of Calcium and Vitamin D3
(Osteoporosis Canada)

Age in years Calcium (elemental) Vitamin D3
4 to 8 800 mg 200 IU*
9 to 18 1300 mg 200 IU*
19 to 50 1000 mg 400 IU
Greater than 50 1500 mg 800 IU

* Health Canada recommendation

Strong bones for a lifetime

Everyone – young and old – can keep their bones as strong as possible by making healthy lifestyle choices. Whether you have diabetes or not, the strategies to prevent osteoporosis are the same.

Adequate calcium and vitamin D are essential for bone health. Calcium is the main mineral that makes bones strong. Dairy products are a great source of calcium. If you are unable to get enough calcium through your diet, take a supplement. Table 1 shows recommended daily intakes.

To absorb calcium from food and supplements, your body needs Vitamin D. Skin makes this vitamin when it is exposed to sunlight. However, in northern climates like ours, strong sunlight is not available through much of the year. Taking a vitamin D3 supplement is a good way to ensure your vitamin D levels are correct. A confusing assortment of calcium and vitamin D supplements are on pharmacy shelves. Ask your pharmacist to help you choose the best one to meet your needs.

Physical activity is good for bones in many ways. Weight bearing exercise includes activities such as walking, running, dancing, playing sports like basketball and soccer, bowling and doing yard work. Resistance exercise involves working against a force to build muscles that support the bones. Examples include lifting weights, swimming and vacuuming. Exercise improves muscle strength, balance, flexibility and coordination, helping to prevent falls.

If you smoke or have more than two alcoholic drinks a day, you are likely at higher risk of fracture. Try to limit caffeinated drinks such as coffee, tea and soda to four cups or less a day.

Detecting osteoporosis

Many adults may not be aware they have osteoporosis. It does not cause pain until a bone breaks. It is important to be able to detect who is at risk of a fracture.

Bone density or heaviness can be measured, giving some idea of bone strength. A bone mineral density (BMD) test uses a low dose x-ray.

It can predict the chance of a fracture. Bone density, age, a previous fragility fracture, having family members with osteoporosis, and long-term use of medicines such as prednisone, all play a role. Doctors can consider these factors when deciding whether someone’s risk of fracture is low, medium or high. If chance of fracture is high, medicine may be prescribed.

Osteoporosis Canada recommends that anyone over age 65 have their bone density tested. No matter how dense the bone, the chance of breaking it gets higher with as we age. Losing four centimetres or more of height in a lifetime, or two centimetres or more in a year, means that bone density should be checked. It often signals that spine fractures have already happened.

Adults between age 50 and 65 should have their bone density tested if they have one or more major risk factors OR two or more minor risk factors for osteoporosis. (See Tables 2 and 3.) Those under 50 may need bone density testing in special circumstances. Diabetes is not listed as a risk factor for osteoporosis, although it should be considered when looking at overall fracture risk.

Treating osteoporosis

The good news is that when osteoporosis is detected, it can be treated and fractures can be prevented. Many effective treatments are available.

Osteoporosis medication works equally well in people with and without diabetes.

For more information about osteoporosis, go to theOsteoporosis Canada website: www.osteoporosis.ca

Anti-resorptive medicines stop bone from being broken down as quickly. They make bones stronger and more resistant to fractures. Included in this group are the bisphosphonates – etidronate (Didrocal™), alendronate (Fosamax™, Fosavance™, and generics), risedronate (Actonel™) and zoledronic acid (Aclasta™), and raloxifene (Evista™), hormone therapy and calcitonin (Miacalcin™ and generics).

Teriparatide (Forteo™) is an anabolic medicine. It works by building more bone and is prescribed for severe osteoporosis only.

Whatever your age, your bone health is important. Young people with type 1 diabetes can use lifestyle measures, including good nutrition and regular physical activity. This will help bones reach peak density and protect against fractures later in life. A healthy lifestyle will not only keep bones strong to prevent osteoporosis, but will help in managing diabetes as well.

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FAMILY HEALTH is written with the assistance of
Alberta College of Family Physicians
FAMILY HEALTH is written
with the assistance of
The College of Family Physicans of Canada
Alberta College of Family Physicians
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