Brittle Bones and Diabetes Mellitus: What You Need to Know

Editor’s Note: As always, consult your healthcare provider with any questions or concerns about your bone health or medications.

Breakdown of Brittle Bones

Brittle bones and osteoporosis are closely related but not exactly the same thing. Osteoporosis is the loss of bone density, and brittle bones is a lifelong condition that causes bones to break easily, even without trauma. 

The similarities between osteoporosis and brittle bones are: 

• Increased risk of fractures
• Decreased bone strength
• Silent symptoms until a break occurs
• Common in older adults
• Influenced by lifestyle factors

Type 1 diabetes (T1D) is linked to brittle bones, an increased risk of osteoporosis and fractures, especially in the age range between 20 and 60. According to ScienceDirect and the National Institutes of Health (NIH), several factors contribute to brittle bones and T1D:

• Poorly controlled blood sugar levels can negatively impact bone loss.
• Insulin deficiency: Insulin is crucial for bone health, as it helps regulate bone formation and metabolism. When it’s lacking, it can lead to increased bone loss.
• Other risk factors include being female, having a family history of osteoporosis, and long-term use of certain medications.

Patients with T1D often have lower bone density than those without diabetes, and people with type 2 diabetes (T2D) may have compromised bone quality, which can lead to increased fragility and fracture risk.

Symptoms

Unfortunately, brittle bones and osteoporosis often have no noticeable symptoms until a fracture occurs, earning the nickname ‘the silent thief’ because it steals bone mass. Common breaks include the hip, spine, shoulder and wrist.

Treatments and Prevention

Prevention is key, and the earlier, the better. Building strong bones in the early years (childhood and adolescence) and healthy lifestyle choices can significantly reduce the risks of developing osteoporosis and slow the progression in those already diagnosed.  

Interesting Fact: Brittle diabetes is a non-medical term used for blood sugar levels that fluctuate wildly.

What You Can Do Now to Protect Your Bones

Prioritize Nutrition

The connection between food and health is undisputed, especially regarding bone health. A nutrient-rich diet that includes calcium, vitamin D, magnesium, and protein helps maintain strong and healthy bones and prevents osteoporosis and fractures.

Read these T1D top nutrition tips from registered dietitian Rachel Stahl Salzman. 

Key Nutrients for Your Bones

Calcium

Calcium is essential for bone strength. Good sources include dairy products, leafy greens, fortified plant milk, tofu and almonds. You should aim for at least 1,000 to 2,000 mg a day, depending on age and gender.

Vitamin D

Vitamin D helps the body absorb calcium. Fortified foods (eggs, mushrooms, milk, orange juice and fatty fish) and sunlight exposure are excellent sources of vitamin D. Experts from the NIH recommend that 10 to 15 minutes of sun (without sunscreen) on the arms and legs a few times a week can meet our vitamin D requirement. Try to aim for 600-800 IU/day.

Protein

Protein is essential for building and repairing bone tissue. A few sources include eggs, dairy, lean meat, beans, Greek yogurt, and nuts.

Magnesium

Magnesium is essential for vitamin D, as it helps the body utilize calcium and vitamin D efficiently while reducing the risk of osteoporosis. Some magnesium-rich foods include salmon, tofu, chia seeds, bananas, nuts, black beans, and dark chocolate!

Vitamin K

An underrated vitamin, K is vital in blood clotting, wound healing, metabolism, and preventing bone loss. Sources include whole grains, seeds, leafy vegetables and nuts.

Strength Training

Weight-bearing exercise, resistance training, and simply getting moving (walking, jogging, and hiking) all stimulate bone growth and protect bone density.

Plus, you don’t need a gym membership to get the benefits of strength training. Many bodyweight exercises—pushups, squats, lunges, and planks—can be performed at home. Resistance bands, dumbbells and weighted vests are gaining popularity as they can build bone strength.

Keep Your Blood Sugar in Check

We know the damage chronic high blood sugar (hyperglycemia) contributes to nerve damage, kidney damage, eye damage and cardiovascular disease, but it also contributes to the risk of infections and bone loss (osteoporosis, fractures, brittle bones, and osteomyelitis)

Watch Your Medications

Be cautious of some prescribed medications that may contribute to bone loss, especially when used long-term. Here are a few to watch for:

Corticosteroids

Some corticosteroids (prednisone, dexamethasone, hydrocortisone) used for asthma, arthritis, lupus and inflammatory bowel disease can potentially decrease calcium absorption and increase bone breakdown.  

GERD Medications

Some proton pump inhibitors used for GERD, ulcers, and acid reflux (Omeprazole (Prilosec), esomeprazole (Nexium), and pantoprazole (Protonix) may reduce calcium absorption over time.

SSRIs for Depression and Anxiety

Selective Serotonin Reuptake Inhibitors (SSRIs), such as fluoxetine (Prozac), sertraline (Zoloft), and citalopram (Celexa), may interfere with bone density, particularly in older adults.

Check with your doctor as some other medications used for epilepsy, breast cancer, blood clot prevention and type 2 diabetes (pioglitazone (Actos), rosiglitazone (Avandia)) are associated with increased fractures, notably in women.

Lifestyle Factors

Certain factors, such as smoking, alcohol and caffeine intake, can interfere with calcium absorption. Also, maintaining a healthy weight (both underweight and overweight) can protect bones.  

Regular Screening

Ask your physician for a DEXA bone density test. Especially if:

• You’ve had diabetes for many years.
• You have a history of osteoporosis.
• You’re a postmenopausal female.

Other Bone Diseases to Watch For with T1D

Osteoporosis

Osteoporosis, a condition where bones become weak and brittle, increases the risk of fractures. Though it’s more common in women and older adults, men and younger individuals can also develop osteoporosis due to certain medications, genetic predispositions, and medical conditions like diabetes.

Osteomyelitis

People with T1D also have a higher risk of osteomyelitis, a bone infection often caused by bacteria. If left untreated, osteomyelitis can lead to inflammation, pain and serious complications. Chronic hyperglycemia can weaken the immune system, making it more difficult to fight off infections. Common sites of osteomyelitis occur in the feet and toes, so maintaining healthy feet is vital for avoiding foot ulcers and neuropathy (nerve damage).

Preventative Tips:

• Keep glucose levels in check.
• Do daily foot checks for cuts and sores.
• Wear comfortable, well-fitted shoes.
• Treat infections early.

Stronger Bones, Stronger You

Keep your bones healthy to reduce the risk of fractures and support strength for healing and recovery. Most importantly, talk to your healthcare provider about strategies for prevention and management. These include maintaining good blood sugar control, promoting bone health through weight-bearing exercise, and adopting healthy eating habits and lifestyle changes.