The development of osteoporosis in diabetes is caused by a deficiency of insulin in the body, which causes a lack of vitamin D and calcium. The bones become brittle and the diabetic often has fractures, even as a result of minor injuries. According to statistics, 50% of diabetics suffer from osteoporosis. In the absence of therapy, the disease threatens with disability.
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Causes of the disease
In type 1 diabetics, the risk of fractures increases by 6 times.
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Osteoporosis that arose against the background of diabetes is considered secondary, because it is a complication of the underlying disease. An increase in glucose concentration and a lack of insulin in the body inhibits bone mineralization. Diabetes upsets the balance between cells that form and destroy bone tissue (osteoblasts and osteoclasts). As a result, the destruction of bone tissue is ahead of its formation, which makes treatment difficult.
The main causes of bone fragility in diabetes are increased sugar levels in the body and insulin deficiency. In addition, the following risk factors are distinguished:
- burdened by heredity,
- gender (women are more prone to osteoporosis than men),
- hormonal disorder in women,
- passive lifestyle
- small stature of the patient.
Manifestation of pathology
At the initial stage of development, diabetic osteoporosis does not manifest itself in any way or is perceived as manifestations of osteochondrosis. Gradually, the disease progresses, and bone damage takes on an irreversible character. Bones become brittle and brittle. Before this, the following symptoms develop:
Brittle nails should alert the diabetic.
- violation of posture
- pain in the muscles and joints before the weather worsens,
- tooth decay
- pain in the lower back when a person is sitting or standing,
- fragility of nails and hair,
- night leg cramps.
What is the danger?
The main danger of osteoporosis in diabetes is a mutual aggravation of disease. Due to high sugar and low insulin, bone tissue becomes brittle, and poorly healed fractures often occur. Particularly dangerous is a fracture of the femoral neck, which is difficult to treat. The specific course of diabetes increases the risk of injury. As a result of hypoglycemia, a diabetic can lose consciousness and be injured. At the same time, the chance to avoid fractures is low. In addition, the risk of injury in diabetes, and as a result, the occurrence of a fracture due to osteoporosis, increases if there are such complications of diabetes:
- decreased visual acuity due to retinopathy,
- jumps in blood pressure, hypotension,
- diabetic foot
- violation of innervation (supply of organs with nerve cells) due to neuropathy.
The treatment of osteoporosis with diabetes mellitus is based on prevention methods. To eliminate any complications of diabetes, including those affecting bone tissue, you need to adjust the sugar level with the help of drugs and a certain lifestyle. In addition, to strengthen the skeleton, the patient is prescribed a diet and drugs with a high content of calcium.
To prevent the development of osteoporosis, you need to control the level of glucose and provide the body with calcium and vitamin D.
If a diabetic has signs of osteoporosis, he is prescribed “Calcemin” or “Chondroxide” - drugs that provide nutrition and strengthen bone tissue. Often used bisphosphonates that prevent bone breakdown and seal them. Treatment is prescribed by a doctor, an independent change in the dosage of bisphosphonates leads to the development of side effects, such as disruption of the digestive tract and weight gain. Women during menopause are prescribed calciotin protein, which is available in the form of a solution for injection or a nasal spray. Calciotin intake is orally ineffective, because it is digested before it has time to act.
Nutrition for Osteoporosis
Correction of nutrition, which implies therapy of osteoporosis, should take into account the daily requirement of the body for water. Diabetics need to drink a lot. Water provides a normal distribution of nutrients throughout the body and elimination of toxins. To get the necessary vitamin D, regular walks in the sun are recommended, and the body should receive calcium, vitamins and minerals from food. In the diet should be:
Prevention of osteoporosis in diabetes
Prevention of increased fragility of bones against the background of diabetes coincides with the prevention of any complications of pathology and comes down to observing special rules for diabetics that correct a person’s lifestyle. It is important to regulate sugar levels. It is the increased concentration of glucose in the body that leads to osteoporosis. In addition, the following recommendations should be followed:
Fracture prevention - regular muscle stretching exercises.
- Do not cancel arbitrarily prescribed treatment.
- Do not skip meals.
- Go in for sports to ensure the normal state of muscles and joints.
- Avoid excessive physical exertion.
- Perform muscle stretching exercises. High muscle tone protects bones from fractures during injuries.
- Provide the body with vitamin D and calcium. It is recommended to consult with your doctor and periodically take vitamin complexes.
Caffeine removes calcium from the body, so diabetics should refuse to use any caffeinated products.
To prevent falls, you should wear comfortable shoes, refuse morning runs for public transport. The floors in the apartment should not be rubbed with mastic or wax, and carpets should not slip on linoleum. In the aisles there should not be extra things and wires for which you can catch. A diabetic should always carry a mobile phone with him, in order to be able to call for help in any unforeseen situation.
Where is the connection between diseases?
Violations of metabolic processes in the body leads to a change in the chemical composition of bone tissue, which is the reason for the development of pathologies of the musculoskeletal system. Diabetes mellitus is characterized by malfunctions in the metabolism of carbohydrates and water, while pancreatic dysfunction develops, which stops producing the vital hormone - insulin. As a result, the processing of sugar into glucose is disrupted, which is accompanied by its accumulation in the body. Such processes negatively affect the mineral saturation of bone tissue, since without insulin calcium absorption is suspended and the absorption of vitamin D is impaired, which takes part in the formation of bone cells.
Low mineralization is considered one of the main reasons for the development of osteoporosis, which is characterized by a decrease in bone density with its further thinning.
Why is it developing?
Diseases associated with the destruction of bone-cartilage tissue occur as a secondary phenomenon in violation of carbohydrate metabolism. Insulin deficiency, which develops against the background of diabetes mellitus, leads to pathological changes in metabolic processes in the bone. There is a violation of the production of osteoblasts, which makes the bones fragile and vulnerable.
Increased blood sugar provokes a violation of intracellular protein production, which negatively affects the state of bone tissue. Insufficient bone mineralization, which occurs against the background of insulin deficiency, leads to bone resorption, which is characterized by tissue degeneration when exposed to osteoclasts. This causes a change in the mineral composition and breakdown of collagen in the bone.
In addition to high sugar content, brittle bones in diabetes can cause the following factors:
- genetic predisposition
- elderly age,
- hormonal disorders
- lack of exercise
- musculoskeletal injuries,
- unbalanced nutrition
- violation of phosphorus-calcium metabolism,
- bad habits.
How to recognize
Initially, there are no manifestations of osteoporosis in diabetes. The first signs occur against the background of significant changes in the structure of bones, and is diagnosed after a fracture. The main symptoms of the disease include:
- a change in the tone of muscle fibers,
- pain in the spine and large joints during movement,
- night cramps
- change in posture
- lumbar pain in a sitting position,
- destruction of tooth enamel,
- deterioration of hair and nails.
Diagnosis of diabetes with osteoporosis
To make a diagnosis of diabetes, the doctor collects an anamnesis, conducts a clinical study of blood and urine for sugar, glucose and carbohydrate content. If osteoporosis is suspected, instrumental studies are performed. Radiography is used to detect dystrophic changes and microcracks in the bone. MRI and CT are used to establish minimal structural changes in bone tissue. A blood and urine test is also performed to determine the state of phosphorus-calcium metabolism.
How is the treatment going?
Therapeutic measures for osteoporosis and diabetes are aimed at preventing the active development of the pathological process and eliminating negative symptoms. Drugs are used to help lower sugar levels, accelerate bone cell regeneration and prevent bone loss. Vitamin-mineral complexes and dietary supplements are widely used.
In women during menopause, the risk of a femoral neck fracture increases by more than 5 times, so it is recommended that hormonal medications be taken to normalize the condition.
For the treatment of ailments, diet food is used. Vegetables, dairy products, fatty fish, nuts, greens are introduced into the diet. Such products help lower sugar, strengthen bones, speed up blood circulation and improve the functionality of the muscle corset. The use of caffeine, animal fats and sweets is excluded.
In patients with diabetes, a condition such as hypoglycemia may occur, which is accompanied by weakness and loss of consciousness, which increases the risk of fractures. It is therefore recommended that you wear a diabetic bracelet to keep your glucose level under control. To avoid the development of osteoporosis, diabetics need to lead an active lifestyle and eliminate bad habits, monitor the timely intake of drugs, and avoid deviations from the main therapy. It is important to eat small meals regularly. It is recommended to take prophylactic mineral complexes according to the doctor's recommendations. To minimize the load on the skeletal system, it is necessary to strengthen the muscle corset, for which stretching exercises are suitable.
Osteoporosis and diabetes
What kind of strange word is osteoporosis? And what does this condition have to do with diabetes?
Let's figure it out. In Greek, osteon is bone, and poros is pore, hole. Our bones are made up of small laths that fit fairly tightly together. If the body is in order, then the crossbars are in order. Lack of calcium and protein, as well as inadequate physical activity violates it: the laths become thinner, so cracks appear between them, the bone inside looks like a treat loved by children - a loose cotton candy. Everyone knows how “strong” it is ... That’s about how the bone will be. In the early stages, when the process has just begun, bone strength decreases slightly - this condition is called osteopenia. The bone still withstands loads and impacts, but if measures are not taken in time, progression is inevitable. And then, loads and blows become very dangerous.
Osteoporosis is currently considered the fourth non-communicable epidemic disease after cardiovascular, cancer and diabetes. True, I would put obesity ahead of this list, but scientists know better. Osteoporosis is also called a silent epidemic - for too long people do not notice the changes that occur with them. On radiographs, bone manifestations characteristic of osteoporosis are detected when the bone has already resorbed by 20%. It's late - with such a loss of strength, fractures can occur without any external effort, for example, when turning in bed during sleep. But is all this not manifesting itself at all? And how do we usually assess pain in the spine, especially if they occur with awkward movement, weight lifting? Well, of course ... Sciatica. Sometimes it’s really him, often such pain is a sign of osteoporosis.
What is the connection with diabetes? Let's figure it out. First, some statistics. It was established that in women over 50 years of age, a femoral neck fracture in the presence of type 1 diabetes mellitus is 7 (!) Times more common than in women of the same age but not suffering from diabetes. In case of type 2 diabetes, the indicators are not so impressive, but nevertheless fractures occur 2 times more often in those who suffer from them than in those who do not have diabetes (again, women over 50). Is there a connection? I think no one has any doubts. Of course have. Such statistics have forced modern endocrinologists to talk about the underestimated complication of diabetes. What is still happening?
First of all, insulin itself is involved in the formation of bone tissue - directly and indirectly through an insulin-like growth factor, the production of which is also enhanced by insulin
Both of them stimulate the synthesis of proteins that make up the bone, and if insulin is low (as in patients with insulin-requiring diabetes), bone formation is impaired. It must be said that the processes of resorption and the formation of new tissue in the bones occur continuously and continuously throughout life, and the outcome depends on their balance: if resorption predominates over the reconstruction, the bone slowly enters a state of osteoporosis.
Secondly, diabetic microangiopathy disrupts blood circulation in the bone. Her nutrition is deteriorating, which is not the best way affects the state of bone tissue.
Thirdly, kidney damage in diabetes disrupts the formation of vitamin D, and without it, it is impossible to assimilate calcium obtained with food, the loss of which due to the same renal impairment already increases significantly.
In addition, diabetes mellitus with its complications creates additional conditions for increased injuries. Visual impairment, unstable gait in diabetic foot syndrome and cerebral arteriosclerosis, impaired consciousness with hypoglycemia, a sharp decrease in blood pressure with autonomic neuropathy (orthostatic hypotension) - all this can increase the frequency of falls, and, accordingly, the risk of fractures, especially if the bones are weak.
What should be done to prevent fractures?
To begin with - control your condition. At the very least, check the calcium content in the blood (it is necessary to look at total and ionized calcium). It will be bad if it is lowered, but not better if it is increased (in this case, calcium is deposited in the walls of blood vessels and in the internal organs, seriously disrupting their work). It must be kept in the range of normal values - this is vital.
However, normal calcium levels are by no means a guarantee of bone well-being. The body strives by all means to maintain blood calcium levels within well-defined values. Any means are good for this, and he “drives” calcium from the bones. The main thing is blood! Blood, not bones ... And while the bones have a little bit of mobile calcium, the body will take it from the bones and thereby keep its concentration in the blood at a vital level. Only when calcium in the bones is not enough, its plasma level will begin to decline. So this indicator will indicate a problem at a far advanced stage.
So, additional sources of information are needed. They can be the level of phosphorus and magnesium - elements that are actively involved in bone formation. In addition, parameters of bone resorption will be parameters such as osteocalcin, telopeptide (Cross laps) and parathyroid hormone. All of them are determined in venous blood taken on an empty stomach. From them, in the future it will also be possible to judge how the prescribed treatment helps. But the most informative special study is X-ray densitometry. Conventional bone radiography will only detect osteoporosis at those stages when the process has already gone so far as to require very intensive, massive treatment, which may be accompanied by rather severe side effects and may not always produce the desired result.
The study of bone tissue - densitometry.
Densitometry allows you to find out about the problem when bone deficiency is 2-5%. This makes it possible to take action on time and with less effort. This study can be carried out in two ways: x-ray diagnostics (RD) and ultrasound diagnostics (ultrasound). In both cases, the speed of the beam (x-ray or ultrasound) through the bone tissue is determined, and bone density is then calculated from it. Ultrasound examination provides information on the condition of the calcaneus, tibia, and phalanx of the fingers. These bones with diabetes mellitus are "strewed" last, therefore, the conclusion about the absence of osteoporosis, made on the basis of this method, may be inaccurate. An X-ray study allows you to see the status of the main problem points - the spine and neck of the femur. The radiation dose is negligible - it does not exceed that which every day a resident of a big city, in particular a Muscovite, gets, just going out.
The problem is that not all laboratories do densitometry and analyzes for markers of osteoporosis, so sometimes only preventive treatment has to be prescribed. But at least calcium in the blood must be controlled, since the normalization of its level will indirectly indicate the adequacy of the prescribed therapy. In addition, with too intensive treatment, the level of calcium may rise more than planned: you will get kidney stones, gall bladder, or somewhere else where they should not be.
How to be treated? Calcium or special medications?
How to treat you, the doctor decides. Mild cases will require the use of calcium and vitamin D preparations; in more severe cases, specific drugs that enhance bone restoration processes will be required.
Osteoporosis therapy - the process is long, unpleasant (specific drugs have no less specific side effects), and it is expensive, which should not be forgotten either. Therefore, prevention and prevention again!
It is advisable to take calcium preparations with vitamin D daily in the form of separate tablets, drops or as part of vitamin-mineral complexes. We need rational physical activity, during which the blood supply to the bones improves, the delivery of nutrients to them, and the incorporation of calcium into the bone tissue accelerates.
And of course, no one took off the agenda the inclusion of calcium-rich foods in the diet. What kind of products are we will discuss a little later, when we will talk about the role of minerals in human life and about their place in the diet of a patient suffering from diabetes.
Causes of Osteoporosis in Diabetes
In diabetes, secondary osteoporosis develops, that is, it is a complication of the underlying disease. With hyperglycemia and insulin deficiency, the rate of mineralization of bone tissue decreases, protein is produced less and less, which adversely affects the processes of bone formation.
In addition, diabetes mellitus causes an imbalance between osteoblasts (cells that form bone tissue) and osteoclasts (cells that destroy bone). One osteoblast can destroy as much bone as one hundred osteoclasts produces right away.
Bone tissue destruction is much faster than its production. This pathological process seriously complicates the therapy.
Insulin resistance and hyperglycemia cause excessive brittleness and fragility of bones, and additional risk factors include:
- genetic predisposition
- female gender (men get sick less often),
- frequent malfunctions of the menstrual cycle,
- sedentary way of life,
- short stature.
Bad habits, long-term treatment with heparin, corticosteroids, anticonvulsants, consumption of high doses of caffeine, lack of vitamin D, calcium, also negatively affect bone tissue.
What is the danger, symptoms
Osteoporosis in diabetes mellitus is dangerous because the diseases exacerbate each other. Insulin hormone deficiency becomes a prerequisite for the progression of bone tissue destruction, in such diabetics the probability of fractures increases, and femoral neck fractures are especially common. It is extremely difficult to treat such injuries, the bones are very fragile, poorly fused.
Diabetics are more likely than others to fall and get a fracture, the likelihood of falling at times increases due to hypoglycemia, when blood sugar levels rapidly fall. Signs of this condition are characterized by clouding of consciousness. Doctors are sure that with diabetes there is very little chance that it will be possible to avoid a broken bone in the fall.
Other causes that increase the risk of osteoporosis and diabetes mellitus will be:
- signs of blurring and decreased vision (caused by retinopathy),
- changes in blood pressure, the risk of hypotension,
- development of diabetic foot
- innervation associated with neuropathy.
If a diabetic often has a jump in blood pressure, he loses control over what is happening.
The symptomatology of osteoporosis at an early stage can be minimal, it is often masked as manifestations of osteoarthrosis or osteochondrosis. At the beginning of the pathological process, the patient will notice changes:
- soreness in joints, muscles,
- cramps at night,
- excessive brittleness of teeth, hair, nails,
- back pain with sitting or standing work.
As you know, these manifestations of osteoporosis in diabetes mellitus are irreversible, if the disease progresses, symptoms increase, bone fragility increases.
Nutrition for Bone Strength
A balanced diet for any type of diabetes always helps to increase bone strength, reduce the likelihood of fracture. It is necessary to carefully choose foods, pay attention to foods rich in vitamin D. Mineral is necessary to strengthen the immune system, blood-forming system, calcium metabolism.
It is difficult to overestimate the role of calcium, it not only contributes to the growth of bone tissue, but also is responsible for the level of pressure, the conduct of nerve impulses, the secretion of hormones, metabolism, maintaining vascular tone, relaxation and muscle contraction. It often happens that calcium deficiency and diabetes are two concomitant pathologies.
The combination of calcium with vitamin D works as an oncoprotector, protects body cells from degeneration into cancerous. If a person has diabetes, this is especially necessary for him.
A diet aimed at combating osteoporosis must necessarily be enriched with minerals, protein. It has been shown to minimize caffeine intake as it leaches calcium. The menu should include:
- milk products,
- sea fish,
- fresh vegetables.
Since diabetics should not consume fatty foods, it is necessary to choose lean varieties of fish, and dairy products with a reduced percentage of fat content. Dr. Rozhinskaya recommends including kefir in the diet.