Why are people with diabetes at higher risk of fractures?

Why are diabetics prone to fractures? Studies have shown that both type 1 and type 2 diabetics have a higher risk of fractures than the general population. Type 1 diabetics usually develop at a critical age when they are at the onset of the disease, which can easily lead to bone loss.

Type 1 and type 2 diabetics have a higher risk of fractures than the general population
A Norwegian study found that the fracture rate of type 1 diabetics in women is significantly higher than that of non-diabetic women, and this risk is related to the duration of diabetes. In other words, the longer you have type 1 diabetes, the higher the risk of fractures in the future. The same finding was also found in a study of women's health in Iowa, USA, that women with type 1 diabetes have a 12.25 times higher fracture rate than non-diabetic women.
Type 1 diabetics usually develop at a critical age when they are at the onset of the disease, which can easily lead to bone loss. In comparison, although type 2 diabetics often have overweight conditions, which makes their bone density appear normal or high, their peripheral neuropathy and impaired vision make them prone to falls, thereby increasing the risk of fractures.

Advanced glycation end products affect bone health
In fact, the fact that diabetic patients are prone to osteoporosis is related to bone density and bone structure. Bones account for about 15% of the body weight. Bones, like other organs, need a good energy supply, and the most important source of energy supply is glucose. Diabetic patients cannot use glucose normally, so there will be problems with bone formation.
Diabetes can affect bone health in many different ways. Among them, high blood sugar and its derived advanced glycation end products (advanced glycation end products) and pro-inflammatory cytokines promote bone resorption, reduce bone formation, and have an adverse effect on bone density. In addition to reducing bone density, diabetes may also affect the micro-architecture of trabeculae, causing the mechanical structure of bones to be fragile.

Deterioration of bone structure + easy to fall = fracture
There are many factors that cause diabetics to fall easily, such as peripheral neuropathy, retinopathy, diabetic foot wounds or amputations, postural hypotension, hypoglycemia, etc. "Deterioration of bone structure" plus "easy to fall" make diabetic patients more prone to fractures than ordinary people.

1. High urine sugar can cause osmotic diuresis, resulting in a large loss of calcium and phosphorus from the urine. Negative calcium balance leads to secondary hyperparathyroidism, increased secretion of parathyroid hormone, stimulating osteoclasts, enhancing osteolysis, leading to bone decalcification and osteoporosis.

2. Osteoblasts have insulin receptors on their surface, and insulin has a regulatory effect on the normal physiological function of osteoblasts. The absolute or relative lack of insulin secreted by diabetic patients weakens the osteoblastic effect.

3. When diabetes is complicated by renal damage, the number and activity of renal 1a hydroxylase decrease, and the synthesis of active vitamin D decreases, thereby affecting the intestinal absorption of calcium.

4. A considerable number of diabetic patients have hypogonadism, and the lack of sex hormones will promote and aggravate osteoporosis.

5. When diabetes is combined with microvascular disease and nerve damage, it will affect the nutritional supply of bones, causing bone nutrition disorders and bone lesions.

According to the recommendations of the Osteoporosis Society, women over 65 years old and men over 70 years old should undergo bone density examinations. For diabetics, controlling blood sugar is the key to reducing the risk of fractures, as it helps reduce the occurrence of neuropathy and retinopathy. In addition, diabetics should learn to avoid and properly handle hypoglycemia, and regularly do exercises that help strengthen bones, such as brisk walking. These measures can effectively reduce the risk of falls and fractures.