Diabetes mellitus is a group of metabolic diseases that cause chronic hyperglycemia due to defective insulin secretion or insulin resistance. Chronic hyperglycemia causes dysfunction of many different organs, especially the eyes (diabetic retinopathy and cataracts), kidneys (diabetic nephropathy), nerves (neuropathy) diabetic menstruation), cardiovascular (diabetic cardiomyopathy). Additionally, diabetes has been linked to metabolic bone diseases, osteoporosis and fracture.
Patients with type 1 diabetes, this risk increased 6 times due to low bone mass. Although bone mineral density is increased, patients with type 2 diabetes have a double risk of fracture due to poor bone quality. The decrease in bone strength in type 2 diabetes is not reflected by bone mineral density, which is dependent on impaired bone quality rather than loss of bone mass.
Diabetes increases the risk of fractures very high. Why is that? According to the Arthritis Foundation, diabetics have a fracture rate 2 to 4 times higher than healthy people.
1. Diabetes reduces bone mass (the main reason cause of fracture)
Diabetes is considered to be the cause of “secondary osteoporosis” due to a loss of bone mass. Studies have shown an increased risk of fractures with poor blood sugar control. The problem of poor glycemic control is determined by a concentration of glycated hemoglobin A1c (HbA1c) ≥ 7%. Poor blood sugar control promotes earlier and more severe small vascular complications. From there, it affects indirectly the change of skeletal microstructure, reduces the strength of the skeleton, increases the risk of falls and fractures due to osteoporosis. Diabetes is a predictor of an increased risk of falls and fractures due to osteoporosis. Diabetes is a predictor of an increased risk of death after fracture in hip fracture patients.
According to a study published in the journal Metabolism, diabetes is a direct cause of increased risk of fractures caused by bone loss (or osteoporosis) and seriously affects the health of patients. Diabetes increases insulin resistance (a hormone that plays a role in regulating and reducing blood glucose levels).
In addition to low bone mineral density, other issues such as age, sex, body weight, a history of previous fractures, smoking, corticosteroid use and rheumatoid arthritis are considered risk factors of osteoporosis fractures. Both types of diabetes contain risk factors for osteoporosis-related fractures. In patients with type 1 diabetes, the risk of fracture increases 1.3 to 3 times for any fractures and 2.4 times for fracture of the foot. More seriously, it increases the risk of hip fractures by 6 to 9 times.
Nutritionists – Biologist Pam Hinton said: “Most of the mice sedentary, obesity and diabetes a decrease structure and increase the hardness of the bone causes bones to break easily than the other group. The mices that were trained, ran on wheels had stronger bones and had less diabetes than other mice. After a study on mices, they said that: Weight gain and diabetes always develop in parallel with insulin resistance, making bone growth impaired.
In the US, a study on osteoporosis (VOS), found that the bone density SSI (stress – strain index to estimate bone strength) of diabetics is often lower than the non-diabetic group so they have The risk of fracture is much higher than that of healthy people.
2. Diabetes reduces bone metabolism
Deterioration create bone cells:
Insulin is a factor affecting bone metabolism, impaired bone mass and structure. When bones are formed, insulin contributes to the proliferation of osteoblasts.
Diabetics often have insulin deficiency, which means reducing Osteocalcin (bone metabolic index) corresponding to a decrease in bone mass with a low metabolic cycle in the body. Therefore, people with diabetes are very susceptible to osteoporosis complications, which directly affect their quality of life.
Increased calcium and magnesium in the urine:
Diabetes increases the risk of fracture due to calcium body excreted out through urine. Diabetic patients are insulin deficient – increasing blood sugar puts pressure on the kidneys, stimulating the kidneys to excrete more. The fact that the patient has a need to urinate more accidentally brings calcium and magnesium out of the body, making the amount of calcium needed for bone formation is insufficient.
The excretion of calcium and magnesium leads to a lower bone metabolism.
Lack of active Vitamin D:
Active Vitamin D is a vitamin created by the kidneys with the function of helping the intestine absorb calcium under the action of insulin. Diabetics will reduce insulin production or insulin resistance, then the active vitamin D when entering the intestines will not be able to help the intestine absorb all of this calcium.
Activated vitamin D is also involved in the process of enhancing the function of osteoblast bone born. However, the increase in blood sugar has made this use of active Vitamin D not promote well.
Reducing the amount of collagen essential:
An indispensable component of bone is protein, in which normal collagen plays a very important role in forming protein, keeping bones always strong.
– The diabetes with high blood sugar levels cause increased protein glycation phenomenon – factors that reduce the normal amount of collagen on, makes bones brittle, easily broken.
Diabetes causes kidney complications:
Kidney complications – a dangerous complication of advanced diabetes that can cause a number of bone diseases due to increased parathyroid function, decreased vitamin D active type, … These diseases will be different from osteoporosis But also diseases that make bones more prone to fracture.
Diabetes promotes bone destruction, causing fracture:
Several studies demonstrate that the risk of fracture feet and toe bones of diabetics is 3 times higher than normal people due to the effects of complications: neurological, vascular disease, vision loss or blindness of diabetes-induced diabetes.
People with diabetes often have metabolic and endocrine disorders, vascular disease that reduces bone nutrition, causing fractures.
3. Anti-diabetes drugs affect fracture risk
Oral hypoglycemic pills used to treat diabetes may affect the risk of fracture. Which include groups of thiazolidinediones, biguanides, sulfonylureas, specifically:
- Thiazolidinediones (rosiglitasone and pioglitasone) increased the risk of fractures by 1.4 times. This group of drugs reduces bone mineral density in the lumbar spine and femoral neck. Treatment with thiazolidinediones increases the risk of fractures in women with type 2 diabetes regardless of the patient’s age and duration of treatment.
Thiazolidinediones activate the proliferating peroxisome receptors (PPARs) that promote fat formation. Mesenchymal stem cells can differentiate to form fat cells and bone-forming cells. PPARs are important regulators of fat cell formation differentiation. The increased risk of fractures with thiazolidinediones may be due to the activation of mesenchymal stem cells towards fat rather than bone formation.
- The biguanide group is the most widely used in the treatment of diabetes. The typical example for this group is metformin. Metformin has a bone-forming effect when investigated in the laboratory, but in clinical studies, metformin reduces bone mineral density in the lumbar spine and femoral neck. Some other studies show that Metformin can increase bone formation, increase bone density or do not change bone density.
Overall, metformin does not appear to have significant effects on skeleton health but is still under study. It can be either neutral or positive on the skeleton itself, making the drug widely used and becoming a safe option for bone health.
- The sulfonylurea group was associated with a 1.46-fold increased risk of femoral neck fracture. Although scientists have not yet demonstrated a direct mechanism of sulphonylurea effects on bones, epidemiological data have shown an increased risk of fractures in patients treated with this drug. Sulfonylurea increases fracture risk which can be explained by hypoglycemic events and increased risk of falls.
- Canaglifozin has been linked to bone loss and an increased risk of hip fractures. Canaglifozin reduces bone density in the hip bones, increases bone turnover, increases rates of falls and fractures. The mechanism of canaglifozine’s negative effect on bone is not entirely clear, but the SGLT2 inhibitor inhibits glucose reabsorption in the kidney and increases the reabsorption of phosphate, thereby increasing the concentration of possibly intact serum phosphates. causes PTH and increases bone turnover.
- Glucagon-like peptide-1 (GLP-1) and dipeptidyl peptidase-4 (DPP-4) analogues do not significantly alter fracture risk in diabetics. Neither DPP4 nor GLP-1 drug groups affect bone structure. This may be due to the positive effect of GLP-1 on bone formation and the low risk of hypoglycemia
- Insulin is an anabolic hormone that acts on bones through insulin receptors IRS-1 and IRS-2. IRS-1 stimulation affects bone turnover, while stimulation of IRS-2 alters the balance between bone formation and bone destruction. Insulin stimulates osteoblast proliferation, promotes collagen synthesis and increases glucose uptake.
Insulin stimulates osteoblast proliferation, promotes collagen synthesis and increases glucose uptake. In type 1 diabetes, insulin and IGF-1 deficiencies, which appear immediately after diagnosis, lead to impaired bone formation, abnormal mineralization, abnormal bone microstructure, and increased brittle fracture. of bone and decreased parietal bone mass. In type 2 diabetes, insulin stimulates the stimulating effect of bone formation and bone mass through its effects on the surface receptor IRS-1 and IRS-2 on osteoblasts.
Hypoglycemia is the most common event in type 2 diabetes that is treated with insulin. Hypoglycemia is closely related to falls and fractures. For newer insulin preparations, there are less hypoglycemic side effects (eg insulin glargine) resulting in a lower risk of fracture. Patients taking insulin (and possibly oral pills with an insulin secretion mechanism) have a higher risk of fracture, due to the indirect effects of falls due to hypoglycemia.
It’s also possible that people who, once on insulin, are synonymous with longer diabetes and / or poor blood sugar control. At that time, diabetes-related complications such as retinopathy and peripheral neuropathy may indirectly contribute to an increased risk of falls and fractures.
4. Recipes keep healthy bones for diabetes
Prevention of osteoporosis with diabetes is a method of maintaining and stabilizing the glycemic index (short term and long term – HbA1c) and preventing atherosclerosis caused by blood fats to help calcium, phosphorus, magnesium and other metabolites rebalanced.
Good glycemic control should be understood as stabilizing blood glucose levels to achieve treatment goals and minimizing hypoglycemic events. Because hypoglycemia is an important cause of falls and fractures in people with diabetes. Optimal blood sugar control is essential to reducing the complications of diabetes, including osteoporosis. However, some antidiabetic drugs are associated with an increased risk of fractures.
To prevent osteoporosis, people with diabetes need:
Exercise, fitness, sports, sunbathing (help increase the production of vitamin D, calcium absorption increased) gently, regularly.
Avoid exercise if your blood sugar is higher than 250 mg / dl (13.75 mmol / l) and you have cetone in your blood or urine.
If you start exercising with high blood sugar, stop for 15 minutes and check your blood sugar again. If the index rises even higher, stop exercising and continue to check your blood sugar periodically for the next 90 minutes. If it has decreased from your pre-exercise level, it’s safe to continue exercising.
– Strict blood sugar control: take medication. Insulin-dependent patients must inject every day, on time, and at the correct dose.
– Healthy diet, scientific activities:
- Limit sugar, starch, sweets; Increase your intake of fiber, green vegetables – roots – fruits.
- Add calcium-rich, skimmed, and sugar-rich milk to prevent osteoporosis, and increase the daily intake of calcium-rich foods.
- Do not drink beer, wine, alcohol and not smoking.
- Weight control, avoid overweight, obesity.
– It is necessary to periodically check and test bone density to detect osteoporosis in time, and have early treatment for osteoporosis.
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