Boost Your Bone Health

Talk of bone health might bring images to mind of little old ladies who fall and break their hips. “That’s not me,” you may be thinking. However, little old lady or not, osteoporosis[1] and an increased risk of fractures are issues that anyone who has diabetes should take seriously. Read on to learn more.

The link between diabetes and osteoporosis
Having Type 1 diabetes[2] is linked to low bone density. While the reasons for this aren’t quite clear, it may be that a deficiency in insulin (meaning, the pancreas stops producing insulin) affects bone growth and strength. Developing Type 1 diabetes earlier in life may limit what is called “peak bone mass,” raising the risk of osteoporosis[3] later in life. Further, complications from diabetes, such as vision problems, foot problems, nerve damage, and low blood sugars, may increase the risk of a bone fracture from falling.

If you have Type 2 diabetes[4], you’re not quite in the clear either. If you are overweight and/or are sedentary, you’re at risk for osteoporosis and fractures, too. As with Type 1 diabetes, part of this risk is also due to a higher risk of falling from nerve damage, vision problems, and low blood sugars.

The big deal about bones
Most of us probably don’t pay too much attention to our bones. They may even seem a bit boring — they’re just “there.” But don’t be deceived: Bones are living tissue — they change all the time. New bone is made, old bone is broken down. Children and young adults make new bone faster than old bone breaks down. At about age 30, most people have reached their peak bone mass. After that, it’s downhill from there — more bone is lost than is gained. But the more you can build your peak bone mass, the lower your risk[5] of developing osteoporosis as you get older. In other words, having extra bone in the bank means that you’re less likely to have problems later on.

Osteoporosis overview
According to the National Osteoporosis Foundation, about 10 million Americans have osteoporosis[6] and another 44 million have low bone mass. One in every two women and up to one in four men over the age of 50 will break a bone due to osteoporosis.

Osteoporosis is a condition in which bones become less dense. This means that bones are more likely to fracture, or break. Having diabetes puts you at risk for getting osteoporosis. Other risk factors include[7]:

• Being thin or having a small frame
• Having a family history of osteoporosis
• Being white or of Asian descent
• In women, being postmenopausal, having an early menopause, or not having menstrual periods
• Certain medicines, such as corticosteroids, anti-seizure drugs, proton pump inhibitors, some anti-depression drugs, and certain diabetes pills (Actos [pioglitazaone] and Avandia [rosiglitazone])
• Eating disorders
• Stomach surgery and weight-loss surgery
• Conditions that affect calcium absorption, such as celiac disease, Crohn’s disease, and Cushing’s syndrome
• Breast or prostate cancer
• Neurological disorders, such as stroke, multiple sclerosis, and Parkinson’s disease
• Not getting enough calcium and/or vitamin D
• Not being physically active
• Smoking
• Drinking too much alcohol

The list of risk factors is long, which helps explain why so many people are at risk for getting osteoporosis. This condition is very serious in that suffering a broken bone (or bones) can cause debilitating complications, such as impaired mobility, loss of height, permanent pain, and a hunched posture.

Getting tested for osteoporosis
Osteoporosis is pretty much a silent disease — that is, until you fracture a hip or wrist. If you have any of the risk factors mentioned above, talk with your doctor about getting a bone density test. One of the most common ways to measure bone density is by having a special type of x-ray. This noninvasive x-ray measures bone density in the hip, spine, and other bones. Also called dual-energy x-ray absorptiometry (DEXA), it involves much less radiation exposure than, say, a chest x-ray. Test results are reported as a score (a T score and a Z score); a negative score means that you have thinner bones compared to a standard. A T score lower than -2.5 indicates osteoporosis. Should you get tested?

• The U.S. Preventive Services Task Force recommends testing for all women ages 65 and older, and for younger women with a high risk of fracture.

• Also, men who are age 70 and older should get tested, according to the National Osteoporosis Foundation.

• If you have diabetes and/or any of the risk factors above, again, have a discussion with your doctor as to whether a bone density test is right for you.

Preventing bone loss and osteoporosis
If only you could turn back time…unfortunately, if you’re older than age 30, you can’t turn back the clock to build up your bone mass. If you’re younger than 30, act now. However, no matter your age, there are steps that you can take to lessen bone loss:

Get enough calcium: Focus on getting enough calcium in your diet. Adults from 19–50, and men ages 51–70, aim for 1,000 milligrams (mg) of calcium each day. Women over 50 and men over 70 need 1,200 mg daily. Food sources include dairy products (milk, yogurt, cheese), dark, leafy greens, canned salmon and sardines with the bones, and fortified foods, such as tofu.

Get enough vitamin D: Aim for 600 international units (IUs) daily if you’re age 19–70, or 800 IUs daily if you’re older than 70. Food sources include fortified milk, egg yolks, fatty fish such as tuna and sardines, and other fortified foods, such as soymilk and some cereals.

Get enough (but not too much) protein: Not eating enough protein can be harmful to your bones. However, overdoing the protein may cause bones to lose calcium. Be careful about eating large portions of meat, poultry, and fish, and/or using protein supplements. Your dietitian can help you figure out the amount of protein that’s best for you.

Go easy with sodium: Too much sodium in your diet can also harm your bones. Most of the sodium that we get comes from processed foods (canned foods, frozen foods, fast foods). Aim for less than 2,300 mg of sodium each day.

Go easy with caffeine: Caffeine can decrease calcium absorption. Limit how much caffeinated coffee, tea, and soft drinks you consume.

Eat a variety of foods: Other nutrients play a role in bone health, too, such as vitamin K, vitamin C, and magnesium. Eating fruits, vegetables, beans, and whole-grain foods are your best bet.

Be active: Aim to be active every day, and choose to include weight-bearing exercises (as you are able) in your routine, such as walking, climbing stairs, playing tennis, and dancing.

Stop smoking: Make a plan to quit smoking. Ask your doctor for help.

Limit alcohol: Don’t have more than two alcoholic drinks each day if you’re a man or one alcoholic drink per day if you’re a woman.

Review your medications: Discuss the types of medications that you take with your doctor, and find out if there are other options if you take medicines that can lead to bone loss.

Keep your blood sugars and A1C in a safe range: This is the best way to limit complications, such as nerve and vision damage, as well as low blood sugars.

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Amy Campbell: Amy Campbell is the author of Staying Healthy with Diabetes: Nutrition and Meal Planning and a frequent contributor to Diabetes Self-Management and Diabetes & You. She has co-authored several books, including the The Joslin Guide to Diabetes and the American Diabetes Association’s 16 Myths of a “Diabetic Diet,” for which she received a Will Solimene Award of Excellence in Medical Communication and a National Health Information Award in 2000. Amy also developed menus for Fit Not Fat at Forty Plus and co-authored Eat Carbs, Lose Weight with fitness expert Denise Austin. Amy earned a bachelor’s degree in nutrition from Simmons College and a master’s degree in nutrition education from Boston University. In addition to being a Registered Dietitian, she is a Certified Diabetes Educator and a member of the American Dietetic Association, the American Diabetes Association, and the American Association of Diabetes Educators. Amy was formerly a Diabetes and Nutrition Educator at Joslin Diabetes Center, where she was responsible for the development, implementation, and evaluation of disease management programs, including clinical guideline and educational material development, and the development, testing, and implementation of disease management applications. She is currently the Director of Clinical Education Content Development and Training at Good Measures. Amy has developed and conducted training sessions for various disease and case management programs and is a frequent presenter at disease management events.

Disclaimer of Medical Advice: Statements and opinions expressed on this Web site are those of the authors and not necessarily those of the publishers or advertisers. The information, which comes from qualified medical writers, does not constitute medical advice or recommendation of any kind, and you should not rely on any information contained in such posts or comments to replace consultations with your qualified health care professionals to meet your individual needs.