We see children bounce around, hop and skip all the time. When we were younger, we could basically do anything we wanted — no pain in the joints and bones yet.We could easily do sports, bend forwards and backwards and not feel a single thing.

But as we get older, we become slower, and we realize that bending to get a coin on the floor now takes so much effort. All the fun and physical activities we used to do have become a little more difficult. As we age, we become more careful, scared of the fact that we might break our hips or arms with careless movement. That’s when we realize that we should have taken care of our bodies, especially our bones, when we were younger. Bone problems are usually associated with age, but little do people know that diabetes could also affect bone health.

Laying Down the Facts
Several studies have found that diabetes affects the bones, although the relationship has yet to be clearly defined. “The reasons for change in bone metabolism in diabetes are not completely clear, but they likely include lack of insulin, high blood glucose levels, and changes in vitamin D and calcium metabolism” writes Belinda O’ Connell, in her article “Boning Up on Bone Health”, published online at the website of Diabetes Self-Management magazine. O’ Connell is a Diabetes Nutrition Specialist at the International Diabetes Center in Minneapolis, Minnesota,and a freelance health and science writer.

Peak bone mass, as defined by O’ Connell, “refers to the point when bone mass is at its greatest and bones are at their strongest.” But this seems to be the problem for diabetics, most especially for type 1 diabetics. Type 1 diabetes patients are believed to be more at risk of developing bone problems compared to those with type 2 diabetes due to their insulin dependency, and also because most type 1 diabetes sufferers are children.

According to Dr. Leilani Mercado-Asis, vice-president of the Osteoporosis Society of the Philippines Foundation, Inc. (OSPFI), type 1 diabetics acquire the disease at an age wherein they are still accumulating bone mass. “They’re at an early stage in trying to make their bones thick, and then the disease comes in. It then becomes a contributing factor as to why their bones are not as thick as compared to non-diabetic people” explains Dr. Mercado-Asis, who is also treasurer of the Philippine Society of Endocrinology and Metabolism (PSEM).

Dr. Evelyn Osio-Salido, president of the Philippine Rheumatology Association (PRA), also believes that insulin deficiency is a big factor for diabetics in achieving optimum bone density. “The earlier the onset of insulin deficiency, the less able these patients achieve peak bone density,” she says.

According to Dr. Mercado-Asir, Filipinos usually attain peak bone mass at the age of thirteen. But sometimes, children as young as four years old may already have type 1 diabetes, and this could greatly affect the growth of their bones.
Although type 1 diabetics are more at risk of having bone fractures because of weaker bones, type 2 diabetics are still not out-of-the-woods just yet. Dr. Teresita Joy Evangelista, president of the Philippine Association of Rehabilitation Medicine (PARM), suggests that poor blood supply to the bones may also compromise bone mass in those with type 2 diabetes.

Diabetes–Osteoporosis Link
Osteoporosis makes the bones more fragile and brittle as it lacks calcium. People with osteoporosis are more prone to cracks in the bones, as well as fractures. Little slips could mean damage to their bones. “If the patient has osteoporosis, which means the bones are fragile,and they have complications of diabetes like imbalance and nerve problems, they are prone to falls. If the bone is thin they are prone to have fractures” says Dr. Mercado-Asis.

Researches suggest that people with type 1 diabetes may not always fall victim to osteoporosis, though they may be more prone to it. “People who develop type 1 diabetes in childhood or adolescence tend to have decreased bone mass as adults, and are more likely to develop osteoporosis and experience fractures than people who don’t have diabetes,” writes O’ Connell.

Though with age and health neglect in our youth, there are just some things we can’t miss out on, and having osteoporosis isn’t any different. Unfortunately for some, diabetes can cause a list of problems. “No matter what type of diabetes a person has, diabetes-related complications such as hypoglycemia, retinopathy and vision loss, and changes in balance caused by neuropathy, can increase the risk of falls and fractures,” says O’ Connell.

Factors That Affect Bone Health
A lot of factors could affect the bone health of type 2 diabetics. “Sedentary lifestyle, poor mobility, and menopause among type 2 diabetics can lower bone density,” says Dr. Osio-Salido. Some studies say that the lack of insulin, high blood glucose levels and abnormal changes in vitamin D levels among diabetics may cause poor bone growth and low peak bone mass. “Delayed puberty and eating disorders, which are quite common among type 1 diabetics, also negatively influence bone density,” adds Dr. Osio-Salido.

Although it is said that people who are heavy set tend to have more protection against bone loss, for type 2 diabetics who are mostly overweight, this may not be the case. Studies have supported claims that type 2 diabetics tend to have more fractures and bone loss compared to non-diabetic people.

Not Just Osteoporosis
According to Dr. Osio-Salido, bones are just half of the problem for diabetics. Joint problems are also common among them.
“Diabetes Mellitus is associated with a wide variety of complications involving joints. In some of these, there is a direct cause;while in others, there is a reported epidemiologic association,” she says. Some of these problems may either be treated with physical therapy, steroids, antibiotics and even surgery.

It is important to keep bones healthy. Healthy bones mean not feeling any pain in the joints and being able to move around freely. You should start keeping your bones in-check at a very young age, not when you start feeling the brittleness of your bones. Kids should be given adequate calcium sources such as milk.

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