Diabetes and bone health: an unexpected connection

Posted: 23/11/2020

Diabetes is a common and fairly well known disease, occurring when blood glucose – otherwise known as blood sugar - is too high. It affects approximately one in 15 people in the UK. The two most common types of diabetes are: Type 1, in which the body’s immune system attacks and destroys the cells in the pancreas that produce insulin; and Type 2, where the body does not produce enough insulin or react well to insulin. There is also a form of the illness called gestational diabetes which can develop in pregnant women, though this usually subsides after the baby is born.

Type 1 diabetes is usually diagnosed in children and young adults and, once diagnosed, those with Type 1 rely on a daily dose of insulin. Type 2 is much more common than Type 1 - around 90% of all adults with diabetes in the UK have Type 2. A build-up of an excess of blood glucose is common to all types of diabetes and, if not managed appropriately, this can lead to many serious health problems such as heart disease, stroke, kidney disease, nerve damage, eye damage and problems with the circulation and feet.

A side effect that is not so widely appreciated, however, is that diabetes can also have a damaging effect on bone health and increases the risk of bone fractures. This connection was demonstrated by a recent study carried out by the University of Sheffield and the University of California. The study highlighted the increase in hip fractures among those with diabetes, particularly Type 1.

Two leading academics involved in the study commented on the urgent need for doctors to be aware of and focus on the bone health of patients with diabetes, especially given the frequency and potential severity of fractures among the older population. Hip fractures in particular can cause disability, and an alarmingly high percentage of people - 20% - are thought to die within a year of a hip fracture.

It is therefore all the more important to take precautionary measures to minimise the risk of developing diabetes in the first place, and to bear in mind the importance of bone health when managing this disease.

Risk factors that increase the chances of developing diabetes, particularly Type 2, include the following:

• being aged over 45;
• a family history of diabetes;
• being overweight;
• a lack of physical activity;
• high blood pressure; and
• having had gestational diabetes when pregnant.

Though some of these factors are clearly outside the control of individuals affected, there are some steps everybody can take to help reduce the risk of developing diabetes and to protect bone health. These include:

• eating lots of vegetables;
• doing plenty of exercise, particularly strength training and weight-bearing exercises; and
• maintaining a healthy, stable weight.

Other steps that can be taken to protect bone health generally include:

• eating plenty of protein;
• eating high-calcium foods throughout the day;
• getting plenty of vitamins D and K;
• avoiding very low-calorie diets (eg fewer than 1000 calories a day);
• eating foods high in magnesium and zinc (for example: beef, shrimp, spinach, flaxseeds, oysters and pumpkin seeds); and
• eating foods high in omega-3 fats (for example: chia seeds, flaxseeds and walnuts).

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