Type 1 Diabetes and Broken Bones: What’s the Connection?

Diabetes slows the healing process. The immune system is disrupted leaving people with diabetes vulnerable to infection and other potential complications. Healing of a bone fracture may be prolonged by as much as 87 percent for people with diabetes, including a higher risk of healing complications.

A number of factors that are part of life with diabetes also mean a higher risk of broken bones.

• Low blood sugar. Also known as hypoglycemia, low blood sugar episodes are often accompanied by symptoms that include feeling faint, disoriented, and unsteady. Their falls resulting from dizziness can lead to bone fractures.
• Hyperglycemia. Over the long term, elevated blood glucose levels may contribute to bone fragility by producing more advanced glycation end products (AGEs). An accumulation of AGEs has been observed along with reduced bone formation in rats with hyperglycemia.
• Diabetes complications. Those who experience diabetes-related complications face a higher risk of bone injury, including those who have reduced vision (caused by a condition called retinopathy) and nerve damage (neuropathy) in the feet or legs, making it more difficult to navigate potential fall dangers.
• Medications. Diabetes medications can lead to a higher risk of bone fractures. Insulin, in particular, has this potential given its glucose-lowering effects that can lead to hypoglycemia. Everyone with T1D must take insulin manually to replace what their bodies don’t produce naturally, and many people with type 2 diabetes (T2D) also take insulin either through injections, an insulin pump, or inhaled insulin. Other diabetes medications, such as those aimed at reducing blood pressure, can lead to dizziness and bring more risk of bone damage.
• Comorbidities. People with diabetes often live with other health conditions, such as thyroid disease, celiac disease, and rheumatoid arthritis. These comorbidities have mechanisms linked to a higher risk of bone fractures.

The primary impacts diabetes complications have on bone health are twofold:

• disrupting physical stability and movement in ways that lead to a greater risk of falls
• disrupting blood flow in a way that undercuts how bone mass is created and maintained

The diabetes complications most commonly associated with bone health are the following:

Retinopathy

The reduced vision that comes with retinopathy, which is when blood vessels in the back of the eye are damaged, can lead to confusion and dizziness and a higher risk of falls and fractures.

Additionally, loss of sight can lead to the person feeling less confident about their physical movement overall. In response, the person reduces their movement and exercise leading to weakened bones and muscles.

In a Korean study, a “significant” association was found between the presence of diabetic retinopathy and the reduction of bone mass density and an increased presence of osteoporosis in women. This finding was significant enough that the researchers suggested that retinopathy might be considered a marker for reduced bone mass density. Interestingly, the same association wasn’t observed in men.

Neuropathy

Nerve damage caused by neuropathy undercuts bone health in two ways: by causing more falls and by disrupting blood flow to bones. With neuropathy, the ability to feel sensations in the extremities and physical coordination are disrupted. Together, these increase the risk of falls and fractures. Additionally, neuropathy can disrupt blood flow to bones, interrupting the bodily processes that build up and maintain bone mass, resulting in bone weakening over time.

Nephropathy

As kidney function deteriorates in nephropathy, the body’s ability to filter blood of waste and regulate hormones that control bodily functions diminishes. Both of these effects disrupt the normal mechanisms that build and maintain bone mass and strength. Over time, the body’s ability to repair bone mass and tissue is undermined.

While people with both main types of diabetes experience a higher overall risk to their bone health, important differences have been observed.

In those with T1D, there’s a higher risk of fractures at an earlier age. This is thought to be because changes in their bone mass seem to happen at a young age. Insulin is an anabolic agent for bones, meaning that it contributes to bone building, and so a deficiency of insulin contributes to low bone formation.

The increase in risk to bone health for people with T2D is associated with how long they’ve had a diagnosis and how much insulin they use. The longer they experience hyperglycemia, the more likely they are to show signs of bone weakening.

For both types, hyperglycemia may contribute to bone fragility by producing more AGEs along with oxidative stress. Both of these factors are associated with a reduced rate of bone formation.

Yes. Traumatic injuries, such as breaking a bone, can lead to stress hyperglycemia. This effect can be present with or without diabetes. Since hyperglycemia can lengthen and undermine recovery blood glucose levels need to be closely monitored and managed when recovering from a broken bone.

Most broken bones are immobilized with a cast or brace. This will limit your ability to move and use the broken part of your body.

Follow a doctor’s orders and take the time to rest and heal. You’ll most likely be told to rest and avoid putting weight or stress on the broken bone.

If there are any symptoms of a complication (swelling, odd sensations such as heat or numbness, bleeding, etc.) get care immediately.

There are a number of things you can do to improve your bone health.

• Manage your blood glucose levels. Chronic hyper- or hypoglycemia undermines bone health and increases the risk of bone fractures. Tight glucose management minimizes their effect.
• Exercise. With regular exercise (both aerobic and weight bearing), you strengthen your bones and circulation. This supports maintaining bone mass and strength. Exercise also can improve your sense of balance, reducing the risk of falls.
• Eating. Food choices are a big part of life with diabetes. A balanced meal plan can be made up of a balanced mix of macronutrients, vitamins, and minerals and supports overall health and the body processes that build and maintain bone and muscle strength. Particularly important are calcium, magnesium, and vitamins D and C. When using nutritional supplements (such as calcium or vitamins), talk with a doctor about the appropriate amounts for you to take.

Bone health is yet another aspect of the body that can be adversely affected by diabetes. This is because of the medications, including insulin, as well as diabetes-related complications that lead to a higher risk. Many of the things suggested to keep bones healthy and strong dovetail easily with things people with diabetes are already advised to do to manage their overall health, including glucose level management, eating balanced meals, and regular exercise.