Why People with Diabetes Are at Increased Risk for Fractures
Understanding the Impact of Diabetes on Bone Health
By Jennifer Peterson, DNP, APRN, LMT, FNP-BC
People with diabetes have a much higher risk for fracture. Skeletal deterioration is a complication of diabetes that is under-appreciated. People with diabetes have subtle differences in the microscopic architecture of the cortical bone, an increase in the volume of pores, which can weaken the bone increasing the chance for fracture. These microscopic changes are not picked up on the typical bone density tests; therefore, clinicians and patients need to be aware of the increased risk for fractures in patients with diabetes.
How diabetes impacts bone quality
High blood glucose decreases the body’s bone-forming cells, the osteoblasts. Chronically high blood glucose leads to the formation of advanced glycation end-products in the bone structure which affects the bone forming cells. The body has a dynamic process of bone remodeling, or bone formation and bone breakdown, that is hindered by the accumulation of advanced glycated end-products in people with diabetes. This leads to deterioration in the bone quality. Lack of insulin and insulin-like growth factor affect bone mass and strength in diabetes. Additionally, higher homocysteine levels seen in diabetes may also be involved in decreased bone remodeling. People with diabetes need to be aware of bony changes and the potential for fracture risk, especially if blood sugar is uncontrolled.
Not only do bony changes lead to fracture risk, but so does the increased risk of falls in patients with diabetes. Falls are more common in people with diabetes for various reasons such as decreased sensation in the feet, reduced vision, increased light-headedness, and low blood sugar. The combination of more fragile bones and a higher risk of falls increases the risk of fractures.
How to prevent fractures
Talk to your doctor about the best treatment options for bone strength and quality. In the meantime, reduce your risk of falls by taking the following preventative measures:
Anchor rugs
Minimize clutter
Remove loose wires
Use nonskid mats
Install handrails in the bathrooms, halls, and long stairways
Light hallways, stairwells, and entrances
Wear sturdy, low-heeled shoes
Hip protectors should be used by patients who are predisposed to falling
Keep all items within reach and avoid using stepstool
About the author
Dr. Jennifer Peterson, Nurse Practitioner, is the Director of Quality Assurance and Integration for GlyCare. She has years of experience managing diabetes for patients in the hospital and now trains other nurse practitioners to do the same. Dr. Peterson also ensures GlyCare provides high-quality services for all patients through a quality review program she created.
References
Bond, Z., Li, D., & Wills, R. (2020). How does diabetes affect fracture risk?
Seaborg, E. (2016, November). Diabetes and bones: An underappreciated complication. Endocrine News.
Trikudanathan, S. (n.d.). The impact of diabetes on bone health. Empower, 9(4).
Learn more about partnering with GlyCare for a turn-key diabetes management service. For more information on how to incorporate either in-person or virtual diabetes management, contact us today.