Healthy Living NT

Diabetes and Osteoporosis – What is the link

28/04/2015 Kerri Rankin, Credentialed Diabetes Nurse Educator, Darwin

Osteoporosis is a bone condition defined by low bone mass, increased bone fragility, decreased bone quality, and an increased fracture risk.

Although osteoporosis traditionally has not been listed as a complication of diabetes, people with either type 1 or type 2 diabetes appear to be among those at increased risk.

Risk factors for developing osteoporosis include:

  • being thin or having a small frame
  • having a family history of osteoporosis
  • for women, being postmenopausal, having an early menopause, or not having menstrual periods (amenorrhea)
  • using certain medications, such as some steroids
  • not getting enough calcium
  • not getting enough physical activity
  • smoking
  • drinking too much alcohol

Osteoporosis is a disease that often can be prevented. However if undetected, it can progress for many years without symptoms until a fracture occurs.

Bone mineral density (BMD) obtained via dual x-ray absorptiometry (DXA) is the most common standard tool for bone mass assessment.

Although DXA is the current way of determining your risk of osteoporosis, it is not a perfect diagnostic tool because there are many bone qualities and bone geometries that are not detectable via DXA. Therefore, a comprehensive risk assessment for osteoporosis should reach beyond bone mineral density measurements for everyone.

This is particularly true when assessing people with diabetes.

Type 1 Diabetes:

Type 1 diabetes has long been associated with low bone density although researchers are unsure why. The mechanism of bone loss in type 1 diabetes is still unknown, although several theories exist.

  • Insulin-like growth factors may influence diabetic bone metabolism
  • Insulin may promote bone growth and strength. As the onset of type 1 diabetes typically occurs at a young age when bone mass is still increasing, it is possible that people with type 1 diabetes achieve lower peak bone mass (the maximum strength and density that bones reach). Thus, low bone mass would seem a likely complication of type 1 diabetes
  • Some people with type 1 diabetes also develop coeliac disease, which is also associated with reduced bone mass
  • Duration of diabetes seems to play a key role given the lower bone mineral density found among people who have had diabetes for longer than 5 years

Type 2 Diabetes:

Type 2 diabetes was previously believed to provide bone protection because of its associated normal to increased bone mineral density.

However, it appears that even though bone density in people with type 2 is increased, so to is the number of reported fractures. As with type 1 diabetes, this may be due to increased falls because of vision problems, peripheral neuropathy, nocturia (getting up to go to the toilet at night) and possible hypoglycaemia. As people with type 2 diabetes can be overweight and sedentary, coordination and balance that can be protective in falls may also be absent.

Additionally the sedentary lifestyle common in many people with type 2 diabetes actually interferes with bone health.

Bone quality changes may also be affected by microvascular (small blood vessel) events common in diabetes.

Bone loss has been observed to be greater in people with poorly controlled diabetes than in those whose diabetes is in good control.

Assessment and Management

While additional assessment measures may need to be considered in diagnosing a person with diabetes for osteoporosis, prevention and treatment is largely the same.

Nutrition: A diet rich in calcium in combination with Vitamin D is recommended. Where individuals are not meeting the recommended requirements, supplements may be used.

Physical Activity: this is an important tool in preventing/treating osteoporosis and ideally weight bearing exercise is best. This will reduce bone loss and enhance balance and flexibility to reduce the risk of a fall.

Healthy Lifestyle: Reducing smoking and alcohol intake will both contribute to healthier, stronger bones.

Bone density testing: Bone mineral density (BMD) testing by way of a dual-energy x-ray absorptiometry (DXA).

Medication: There are a number of medications available in the management of osteoporosis and we would encourage you discussing this with your doctor.

As stated, whilst not currently considered a complication of diabetes, evidence would suggest it is important for your health care professional (predominantly your doctor) to ensure they are adequately assessing and screening you for osteoporosis.


This article was published on Territory Way Edition December 2013, please click here to read more interesting articles.

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