My blog on January 7th provided information on bone disorders in patients with diabetes. The overall conclusion was that diabetes patients are more likely to have bone fractures due to bone fragility and impaired bone structure caused by several factors one of which is improper diabetes management.
Bone formation and bone breakdown is a complex process and should occur spontaneously in all people. However in diabetes a disruption in this process may lead to an increase risk of falls and fractures. If you already have complications you may even be at a greater risk if you suffer from:
· Impaired vision- diabetic retinopathy, cataracts, impaired peripheral and night vision or hypoglycemia
· Poor balance with unsteadiness due to loss of sensation in your feet and toes (neuropathy), foot ulcers, decreased reflexes and frequent urination during the night (result in falls in the dark) going to and from the bathroom.
All people 65 years of age and older should be assessed for fracture risk. If you have had a fragility fracture before 65 and have other risk factors such as low body weight or long term use of medications that increase bone loss, then you should be assessed at an earlier age. I have included this link to the Canadian Osteoporosis Guidelines published in 2010. I read in a news release dated last October that 1.4 million Canadians including an estimated 1 in 4 women and more than 1 in 8 men over the age of 50 are affected by osteoporosis.
There are many options for treatment of osteoporosis, some of which you can discuss with your health care team at any time. Calcium and Vitamin D are important factors in maintaining bone mass. The recommended dietary intake of calcium for ages 51-70 is 1000-1200mg of calcium per day and for those over 70 years 1200mg a day is recommended. Maximum daily allowance is 2000 mg regardless of age. Calcium is found in foods such as milk and cheese but to consume the amount you need from food may be difficult. A dietitian could help you choose foods that work well with your diabetes meal plan.
As a pharmacist I have to caution you about calcium products. Calcium products labelled 1250 mg of calcium is misleading because it contains only 500 mg of the elemental calcium which is the form you need to meet your daily requirements. So please ask for advice from your pharmacist/health care team to be sure you choose the correct product and that you know how many capsules/tablets you need to take to meet your daily requirements.
Vitamin D is a nutrient that helps the body use calcium and phosphorous to build and maintain strong bones and teeth. We all learned in school the importance of the sun and its relationship to the production of Vitamin D. Anyone who spends most of their time indoors could be deficient in Vitamin D. Vitamin D is also required for absorption of calcium. Recommended guidelines can be found in this link. Health Canada recommends that all Canadians over the age of 50 years should supplement with Vitamin D 400 units per day.
There are also treatment options that require a prescription and available from your physician after assessing your risk factors for fractures and bone loss.
Nutrition management of diabetes and osteoporosis should be individualized such that the goals of optimal blood glucose control and calcium intake are met and are safe for you.
Exercise is an important step in strengthening your bones which can decrease the risk of falls and fractures. We also know exercise is good for diabetes management especially in type 2 diabetes. Always check with your health care team before starting any exercise program. Please refer to this link for excellent information on exercise put out by the Osteoporosis Society of Canada.
This has been only a slight review of bone issues and diabetes but I hope it has started you to think about bone disease and its relationship to people with diabetes.
Diabetes can also increase the presence of disorders involving the muscles, nerves, tendons, joints, cartilage and spine. Disorders affecting joint mobility in the hand(s) can be diagnosed and is called Dupuytren's Contracture. The literature tells us that this happens in approximately 15-40% of diabetic outpatients. Frozen shoulder (adhesive capsulitis) is also known to happen and causes shoulder pain and eventual restriction of your shoulder’s movement. When I was being treated for my frozen shoulder at a physiotherapy clinic I happened to mention the small bump in the palm of my hand and how it hurt to extend my finger. It was then that I learned about the Dupuytren’s contracture. I have been the host of both of these disorders and have received several treatments over the years. My words of advice is: at the start of any new and continuous symptom, do not let it linger on and suffer, the earlier you start therapy the better the outcome as I speak from my experiences.
Many other joint disorders are possible in all populations and the existence of these appears to be higher in diabetic patients. It is thought that the duration and control of your diabetes plays a part in developing these conditions, however, they are not necessarily related to your type of diabetes.
This is a massive topic and I have provided only a tiny fraction of the information. As people with diabetes, we often think of complications affecting our eyes, nerves, heart, kidney and often forget about our bone health.
#bone&diabetes
#muscles&diabetes
The information in this blog is not intended to replace information provided by your health-care provider(s).
Thank You for your time once again. Stay safe and healthy.
References:
1)Diabetes Care Community-accessed December 29th,2020
2)UpToDate- accessed on December 30th,2020
3)Diabetes Spectrum -accessed on December 30th,2020
4)Websites/links as above
The above picture was adapted from Grant's Atlas of Anatomy textbook