What Is the Connection Between Diabetes and Bone Disease?

If you have diabetes mellitus—commonly known as diabetes—you are aware of potential complications of diabetes that may affect different body organs, including the eyes, kidneys, and heart. But there is one more thing risk to consider—and that is your risk for bone diseases. Compared to people without diabetes, people with type 1 and type 2 diabetes have a higher risk for fractures, especially of the hip.

Although the relationship between diabetes and increased risk for bone diseases and fracture is not well understood, researchers agree there is a connection and that taking certain measures can lower that risk.

Diabetes

Diabetes is a metabolism disorder. These disorders result when the metabolism process fails and causes the body to produce too much or too little of a substance the body needs to say healthy. In the case of diabetes, that substance is insulin.

As it relates to diabetes, metabolism starts when glucose (sugar) from digested foods enters the bloodstream. Generally, glucose would be used by cells for energy the body needs to perform various functions. But for glucose to enter the bloodstream and provide energy to cells, insulin must be available.

Insulin, produced in the pancreas, is responsible for moving glucose from your bloodstream to cells to provide you with the oxygen you need daily. But in people with diabetes, the body produces too much or too little insulin, or it is not responding correctly to the insulin it is producing.

People with type 1 diabetes, more common in children and young adults, produce little or no insulin. Type 2 diabetes causes the body not to produce enough insulin or to respond inadequately to the produced insulin. It's more common in older people, who might be overweight or inactive and accounts for about 90% of all cases of diabetes.

Bone Diseases Linked to Diabetes

Bone disease is any condition that causes damage to the skeleton and makes the bones weak and vulnerable to fractures (bone breaks). Weak bones are not a normal part of aging, and neither are fractures. And while strong bones begin with childhood, anyone of any age can improve their bone health.

Bone diseases associated with diabetes include osteoporosis, osteopenia, Charcot foot, diabetic hand syndrome, diffuse idiopathic skeletal hyperostosis, frozen shoulder, and Dupuytren's contracture.

Osteoporosis

One of the most common bone diseases is osteoporosis, characterized by low bone mass and structural deterioration of bone tissues. It can lead to bone instability and increased risk of fractures of the hips, wrists, knees, and spine.

Osteoporosis is preventable and treatable, but it affects many people as they age. Globally, one in three women over 50 and one in five men over 50 will experience osteoporotic fractures. Low bone density is associated with osteoporosis, which occurs when bones lose vital minerals, particularly calcium. As a result of this loss, bones become weak and fracture easily. People with diabetes tend to have a lower bone quality, which increases their risk of osteoporosis.

Osteopenia

In osteopenia, bones are weaker than usual. However, bone mass and density are not low enough to cause bones to break easily. Osteopenia can be seen as a middle point between having strong, healthy bones and having osteoporosis.

Research shows that osteopenia is an established complication of T1D, especially in people who use high doses of insulin.

Charcot Foot

Also known as Charcot neuropathic osteoarthropathy, Charcot foot is a complication of diabetes that causes deformities in the foot and ankle. Symptoms include swelling, redness, and visible deformity.

Treatments for Charcot foot include assistive device use (to take the pressure off the affected joint) and custom shoes (to allow the joint to heal). Surgery is considered when other options have failed.

Diabetic Hand Syndrome

Diabetic hand syndrome, also known as diabetic cheiroarthropathy, is a complication of both type 1 and type 2 diabetes where finger movement is limited, and the hands become waxy and thick. Diabetic hand syndrome is more common in people with long-standing, uncontrolled diabetes.

Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH), also called Forestier disease, is a type of arthritis that affects tendons and ligaments—mainly in the spine. DISH causes tissues to become calcified (hardened) and bone spurs to develop in areas of the spine that connect to bone.

DISH can also cause bone spurs in the hips, knees, shoulders, hands, and feet, and calcification of bones throughout the body. T2D, or any other condition that raises insulin, can cause a person to develop this condition.

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, results when ligaments around the shoulder become inflamed and stiff. Both inflammation and diabetes make routine healing harder, causing the shoulder joint to become so stiff that it can make the simplest activities­—like buttoning a shirt­—difficult. 

Frozen shoulder is a painful condition that could take months or years to resolve. It is treated with physical therapy, anti-inflammatory drugs, and corticosteroid injections. Research suggests people with unmanaged diabetes are five times more likely to have frozen shoulder in comparison to their peers without diabetes.

Dupuytren's Contracture

Dupuytren's contracture, also called palmar fascia, is a hand condition that gradually causes the connective tissues under the skin of the hand to become thick and severely scarred. While the disease is not always painful, it does restrict movement in the fingers and may cause them to curl and bend towards the palm.

Diabetes is a risk factor, and people with diabetes carry a 3.06 times higher risk for developing Dupuytren's. People withT1D have the highest risk for Dupuytren's contracture.

How Diabetes Affects Bone Health

Symptoms of diabetes-related musculoskeletal problems include joint pain, swelling, and stiffness, muscle pain, reduced ability to move joints, joint, and bone deformity, and a pins and needles sensation (uncomfortable tingling or pricking) in the arms, legs, hands, and feet.

Uncontrolled diabetes can lead to the breakdown of the musculoskeletal system, which includes your bones, joints, ligaments, and tendons. Diabetes is also linked to arthritis. The term arthritis refers to different types of conditions that cause painful inflammation and stiffness of the joints.

People with diabetes, especially those with T1D, tend to have a lower bone quality and increased risk for fractures. T1D affects young people when their bone mass is still growing. Peak bone mass is the maximum strength and density that bones can reach. Low peak bone mass increases the risk of osteoporosis as you age. 

People who have long-standing diabetes, poor blood sugar control, or who take insulin seem to have the highest risk for bone and joint problems. Additionally, complications of diabetes, including nerve damage, muscle weakness, low blood sugar, and blurred vision, can contribute to falls and fractures.

People with T2D diabetes typically have higher bone density due to increased body weight, so they are often not diagnosed with low bone density or osteoporosis. Without any indication of low bone mass, that means they are not taking opportunities to prevent and reduce the risk for fractures.

Their risk is higher than it is for others in the general population who don’t have T2D. Additionally, there is evidence suggesting the strength of bone in people with T2D is 10% less than their peers without the condition.

Reducing Risk of Diabetic Bone Diseases

For everyone, including people with diabetes, the best ways to preserve your bone health are through regular exercise, a balanced diet, and healthy lifestyle choices.

Regular Exercise

Your musculoskeletal system responds well to exercise by making bones stronger. The best activities for bone health are weight-bearing and strength training exercises.

Weight-bearing exercises include jogging, stair climbing, walking, dancing, yard work, and playing tennis. If you can handle strength-bearing workouts—like lifting weights and doing push-ups, these can also help with making bones more robust and improving balance.

Diet

A daily balanced diet includes fruits and vegetables, lean meats and fish, whole grains, nuts and seeds, and nonfat and low-fat dairy productions, and other calcium-rich foods. Make sure you are getting plenty of vitamin D and calcium for healthy bones.

Lifestyle

Both smoking and alcohol are bad for bones. Women who smoke can enter menopause earlier, which also means they can develop bone loss much earlier due to reduced estrogen. Alcohol can cause bone loss and fractures because people who drink heavily have poor nutrition and increased risk of falls.

You should work with your healthcare provider to keep blood sugar levels managed and controlled. Ask if you need medications to improve bone density and to help prevent and treat osteoporosis and/or reduce the risk of fractures.

If you are still worried about your bone health, ask your healthcare provider about having a bone density test done. This test is a painless way to detect low bone density and osteoporosis.

A Word From Verywell

Having diabetes doesn’t mean you are destined for bone disease. If you know you have other risk factors like family history, talk to your healthcare provider early on, so that you can work together to prevent and spot bone problems before they get worse.

Call your healthcare provider if you develop swelling, redness, numbness, or pain in bones, muscles, or joints. These symptoms need to be addressed as quickly as possible.

While many bone diseases have no cures, treatments can minimize pain, swelling, stiffness, and other discomforts, and reduce the risk for deformity and disability. Most people can have a good quality of life and a positive outlook despite living with diabetes and bone problems.