Diabetes increases bone and joint diseases and fractures

Diabetes mellitus (DM) is a group of metabolic disorders that are increasingly common in modern society. DM contributes to the earlier appearance, more severe or faster progression of musculoskeletal diseases. In recent years, it has been clearly shown that both type 1 and type 2 DM increase the risk of osteoporosis-related fractures.

1. Diabetes increases bone and joint diseases and fractures

Diabetes is a group of metabolic diseases that cause chronic hyperglycemia due to impaired insulin secretion or insulin resistance. Chronic hyperglycemia causes dysfunction of many different organs, especially the eyes (diabetic retinopathy and cataracts), kidneys (diabetic nephropathy), nerves (diabetic neuropathy), and cardiovascular system (diabetic cardiomyopathy). Musculoskeletal complications of diabetic patients are often due to nerve and blood vessel damage combined with decreased resistance, making the body susceptible to infection. On the other hand, the bone density of diabetic patients is 20-30% lower than that of normal people, which is also the cause of many musculoskeletal problems in diabetic patients. In addition, diabetes has been found to be associated with metabolic bone diseases, osteoporosis, and fractures.

Diabetes not only aggravates osteoporosis and osteopenia, but is also a cause of bone fragility. However, the loss of bone strength is different between type 1 and type 2 diabetes. Although the pathogenesis may be different, both types of diabetes reduce bone strength, leading to an increased risk of fracture.

In type 1 diabetes, also known as insulin-dependent diabetes, insulin deficiency leads to hyperglycemia in young people. In addition to the usual neurological complications, both men and women with type 1 diabetes exhibit low bone mass in the hip, femoral neck, and spine, which can ultimately lead to an increased rate of fractures.

In contrast, in type 2 diabetes (non-insulin-dependent diabetes), there is an increase in bone density at the femoral neck. While studies have shown that hip bone density is significantly lower in type 2 diabetes patients compared with age-matched normal individuals. Furthermore, people with type 2 diabetes have an increased risk of fractures at several sites, including the spine and hip. However, these fractures may be due to impaired vision (due to diabetic retinopathy and cataracts), gait imbalance (due to peripheral neuropathy), and being overweight, all of which are common clinical features in people with type 2 diabetes, making them more susceptible to falls, injuries, and fractures. Peripheral neuropathy in type 2 diabetes can also lead to localized destruction of bone around weight-bearing joints (especially in the ankles and feet), known as Charcot osteoarthropathy, which can cause pain, fractures, and joint deformities.

Type 1 diabetes usually occurs in young people before the skeleton reaches peak bone mass. While type 2 diabetes usually occurs in adults who have reached peak bone mass. Therefore, type 1 and type 2 diabetes cause bone damage at different levels. Specifically, in both sexes, bone density at the femoral neck of type 1 diabetes is significantly lower than that of type 2. This difference in severity may be due to insulin deficiency in type 1 diabetes patients, which is a bone-forming factor that can stimulate proliferation and differentiation of osteoblasts. In addition, differences in disease duration between type 1 and type 2 diabetes may contribute to different outcomes and prognoses of bone events.

1. Higher risk of bone fracture in people with diabetes

Both types of diabetes carry risk factors for osteoporotic fractures. In patients with type 1 diabetes, the risk of any fracture is increased by 1.3-3 times and the risk of foot fracture is increased by 2.4 times. More seriously, it increases the risk of hip fracture by 6-9 times.

Furthermore, oral hypoglycemic agents thiazolidinediones (TZDs) used in the treatment of type 2 diabetes directly reduce bone formation by directing mesenchymal stem cells toward adipocytes rather than osteoblasts. Thiazolidinediones have been reported to increase the risk of fractures in both men and women.

In addition to low bone mineral density, several other factors such as age, gender, body weight, history of previous fractures, smoking, corticosteroid use, and rheumatoid arthritis are considered risk factors for osteoporotic fractures.

Increased bone turnover and decreased bone mineral density due to secondary hyperparathyroidism in diabetic nephropathy also predispose diabetic patients to fractures. On the other hand, diabetic peripheral neuropathy causes immobility and decreased bone density, and autonomic neuropathy increases the risk of fractures due to postural hypotension, which makes patients prone to falls.

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Source: https://vade.org.vn/benh-dai-thao-duong-gia-tang-nguy-co-gay-xuong/