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Published on March 20, 2013

Bone Health and Diabetes

By Brenda Patzlaff, RD, LN
Avera Sacred Heart Hospital Clinical and Consultant Dietitian

American Diabetes Association® Alert Day®, held on the fourth Tuesday in March each year, is a one-day "wake-up call" asking the American public to find out if they are at risk for developing Type 2 diabetes. This year’s Alert Day® is Tuesday, March 26, 2013.

Recent studies have shown there may be an increased risk of osteoporosis for people with diabetes. Osteoporosis is the most common bone disorder, causing reduced bone strength, low bone mass and an increased risk of bone fracture. Studies have shown that people with both Type 1 and Type 2 diabetes have a higher incidence of bone fractures than the general population. One theory is that high blood glucose levels can be hard on bone, causing what is often referred to as “brittle” bones. Also, some of the complications of diabetes, such as kidney disease, may impair the function of Vitamin D and the absorption of calcium. In addition, people with diabetes can have impaired eyesight and decreased balance due to neuropathy leading to more falls. Although exact reasons for this increased risk are not completely clear, there are things we can all do to decrease our risk of osteoporosis:

  • A DEXA scan (a type of x-ray) is recommended for all women 65 years or older; all men older than 70 years.
  • Don’t smoke
  • Get adequate calcium and Vitamin D
  • Stay physically active!

The National Osteoporosis Foundation recommends the following guidelines for calcium and Vitamin D:

Sources of Calcium

  • Milk, yogurt, cheese
  • Kale, broccoli, Chinese cabbage
  • Fish with soft bones (canned sardines, salmon)
  • Fortified foods – soy milk, rice beverages, cereals, fruit juices
  • Supplements:
  • Calcium Carbonate – best absorbed with food
  • Calcium Citrate – absorbed with food or empty stomach
  • Take no more than 500-600 mg at one time

Sources of Vitamin D

  • Sunlight!
  • Fatty fish – salmon, tuna, mackerel
  • Beef liver, cheese, egg yolks – small amounts
  • Mushrooms
  • Fortified milk, soy milk, orange juice
  • Supplements:
  • Vitamin D2
  • Vitamin D3

More studies are needed to determine the reasons for the increased risk of osteoporosis for people with diabetes.  By managing blood glucose levels, getting regular physical activity and adequate calcium and Vitamin D, people with diabetes can decrease their risk for fractures.

Sources:
On the Cutting Edge: Diabetes Care and Education; Winter 2012; Vol. 33: No 6, pg 23-26.
www.Diabetesselfmanagement.com; Diabetes and Bone Health; accessed 3/11/13
NIH; Office of Dietary Supplements; www.nih.gov
National Osteoporosis Foundation; www.nof.org; accessed 3/11/13