51-year-old Schwartz. “Instead of a few
weeks, the toe took several months to
heal and for the pain to go away.”Higher risk
For people with diabetes, bone loss
can be a major health concern.
There’s a sevenfold increase in hip
fractures among those with type 1
diabetes and about 1.3-fold increase
among those with type 2 diabetes,
according to a 2016 report.
“For reasons that are still unclear,
people with both type 1 and type 2 dia-
betes experience a higher incidence of
bone fracture than the general popu-
lation, even though people with type
2 diabetes tend to have above-average
bone density,” says endocrinologist
Greeshma Shetty, MD, with the Joslin
Diabetes Center in Boston. “People
with diabetes experiencing bone loss
don’t feel the symptoms and don’t
know they have weaker bones until
they fall and break one.”
Though the bones in the skeleton
may seem as solid and unchanging
as a stone statue, they are in constant
flux. “Our bodies continually break
down and absorb old bone and form
new bone tissue, but lack of insulin or
insulin activity and other factors can
interfere with the formation of new
bone, and that’s when the risk for frac-
tures increases,” says Derek LeRoith,
MD, PhD, professor of medicine in
the division of endocrinology, diabetes
and bone disease, ICAHN School of
Medicine at Mt. Sinai in New York City.Educate early
Bone loss was never discussed as a risk
factor by her doctors, recalls Schwartz.
As a CDE, Schwartz makes a point to
educate her patients early on about
the connection between diabetes and
bone health.
Shetty makes time to talk about bone
health with her patients, especially those
with type 1, who are often diagnosed at
an earlier age. There’s some evidence
that people with type 1 diabetes achieve
lower peak bone mass because of the
deficiency of insulin, which helps pro-
mote bone growth and strength.
“I make sure to talk to my patients
at a relatively young age, even in their20s if they have type 1 diabetes,” says
Shetty. “It’s something that they need
to think about for the future because
I don’t want them to face a crisis. I
want to alert them early on to avoid
any fractures.”Bone diseases
There are several bone diseases that
people with diabetes are susceptible
to, but the most common is osteopo-
rosis. Some 10 million Americans have
osteoporosis, and another 44 million
have low bone mass, putting them
at greater risk of breaking a bone,
according to the National Osteoporo-
sis Foundation. It is a chronic condi-
tion characterized by reduced bone
strength, low bone mass and a higher
risk of bone fracture, especially at the
hip, spine and wrist.
“There are a number of factors that
could contribute to making some-
one with diabetes more susceptible
to bone issues,” says Rachel Stahl,
MS, RD, CDE, senior dietitian at New
York-Presbyterian Hospital. “There are
other conditions that may increase
risk of bone loss, including genetic
abnormalities, chronic kidney dis-
ease, developmental disorders and
rheumatoid arthritis.”Testing time
Currently, there are no recommenda-
tions on when people with diabetes
should have their bones tested. Doc-
tors make a decision depending on
each patient’s risk factors. When a
test is needed, experts recommend
a bone mineral density, or BMD, test
using a central DXA (dual energy
X-ray absorptiometry) machine. It is
simple, painless, takes 5 to 10 minutes
and uses very little radiation.
These tests can measure bone den-
sity at the hip and spine and detect
osteoporosis before a bone fracture
occurs and predict one’s chances of
fracturing in the future. If you are
age 65 or older and at risk, Medicare
Part B covers a bone density test once
every 24 months at no cost to you when
your doctor orders it. “People with
diabetes should talk to their doctors
about when they should undergo a
bone density test,” says LeRoith. SMART STEPS
FOR PREVENTION
There are no magic bullets to avoid bone
health problems, but there are several
prevention measures that can help,
including regular exercise, adopting a
balanced diet and making healthy
lifestyle choices.
EXERCISE FOR LIFE: Bones are living
tissue, like muscle, and respond well to
exercise by becoming stronger. The best
fitness plan for your bones is weight-
bearing exercises such as hiking, jogging,
stair climbing and even tennis. Strength-
training exercises such as lifting weights,
using weight machines or lifting your
own body weight with push-ups can also
strengthen the muscles around the bones
and improve balance.
EATING WELL: A well-balanced diet
should include fruits and vegetables, lean
meats, fish, whole grains, legumes, nuts
and seeds, and nonfat or low-fat dairy
products or other calcium-rich foods each
day. Diets should include plenty of calcium
and vitamin D, which is important for
healthy bones. Good sources of calcium
include low-fat dairy products, dark green,
leafy vegetables, and calcium-fortified
foods and beverages.
LIFESTYLE CHOICES: Smoking has been
found to be bad for bones as well as for
the heart and lungs. Women who smoke
tend to enter menopause earlier, and that
can begin earlier bone loss. In addition,
smokers may absorb less calcium from their
diets. Alcohol can also negatively affect
bone health. Heavy drinkers are more
prone to bone loss and fracture because of
poor nutrition as well as an increased risk
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