Can diabetes, thyroid disorders, and other conditions affect bone health?

Bone health is influenced by more than just calcium consumption and exercise. Various hormones, metabolism, kidney function, and chronic illnesses also affect bone health. For example, diabetes and thyroid disorders can disrupt these processes, thus increasing the chance of developing osteoporosis and suffering fractures. Understanding these relationships can help individuals manage their pre-existing conditions as well as keep their bones healthy.

Diabetes and bone health

Diabetes has the potential to disrupt bones in multiple ways, which may not always be picked up by a routine measurement of bone density. In people living with type 1 diabetes, a lack of insulin combined with alterations in the bones’ development may lead to a decrease in bone density. In the case of people living with type 2 diabetes, their bones may show normal density, or results above average, but this doesn’t mean there isn’t any impairment in their quality and strength. The presence of advanced glycation end products can impact the formation of bones, while fluctuations in blood glucose may affect the structure of collagen, which plays a crucial role in the functioning of bones.  However, diabetes causes damage to the nerves, visual impairments, and episodes of hypoglycemia, which in turn make the risk of falls greater. Thus, they can be prone to a higher risk of fractures despite the favourable results of the bone density measurement.

Thyroid disorders: Why hormonal balance matters

Thyroid hormones contribute to the regulation of bone turnover, which refers to the destruction of old bone and formation of new bone. Excessive levels of thyroid hormones can lead to a situation wherein the breakdown of bone is faster than the formation of bone, culminating in bone loss and a greater risk of fractures. This can happen in untreated hyperthyroidism or when one consumes higher doses of thyroid replacement medication than is needed. This may be even more significant for the elderly and postmenopausal women. Hypothyroidism does not have the same straightforward role in the loss of bone; however, uncontrolled disease, comorbid conditions, and treatment-related issues can affect the general status of the musculoskeletal system.

Other medical conditions that can weaken bones:

There are several other conditions that can impact bone strength in various ways.

• Hyperthyroidism: High levels of thyroid hormone can interfere with calcium homeostasis and facilitate bone destruction in certain types of the disease.
• Chronic kidney disease: The kidneys help in metabolizing vitamin D, maintaining calcium and phosphate balance. These processes can be impaired in the advanced stages of kidney disease, allowing mineral and bone diseases.
• Rheumatoid arthritis: Chronic inflammatory conditions can lead to bone resorption. Lack of mobility along with steroid treatment can exacerbate the risk of fracture.
• Coeliac disease and some other malabsorption conditions: Poor absorption of calcium and vitamin D may impair the process of bone mineralization.
• Premature menopause and hypoestrogenism: Low estrogen levels may lead to bone loss and consequently a higher risk of the disease.

Can medications also affect bone health?

Indeed, long-term use of specific drugs, most notably oral corticosteroids like prednisolone, may cause accelerated loss of bone density, which increases the risk of fractures. Certain anti-seizure medications and treatments may also influence bone metabolism and increase the risk of falling.  Still, patients should never stop taking any prescribed medicines by themselves. Only a healthcare professional can determine individual risks and make a recommendation for monitoring, preventive treatment, or alternative medications.

How can people protect their bones?

People with chronic illnesses should have conversations about bone health with their healthcare provider, especially those patients who are older, post-menopausal, who have suffered a low-energy fracture, or those taking bone-compromising medications. Based on a person's risk level, a clinician might conduct a fracture risk analysis, DXA testing of the bones, as well as some laboratory work. A normal DXA result does not necessarily mean that the person is at no extra risk for fractures, particularly when it comes to diabetes patients.

Bone health can be maintained through a proper diet containing enough calcium and protein, sufficient vitamin D intake, regular weight-bearing and resistance exercises, and fall prevention measures. Also important are the management of the underlying disease and the evaluation of long-term medications used. The following key point should be emphasized: Bone health does depend on general metabolic and hormone health. There are many chronic health disorders (diabetes, thyroid disorders, etc.) that might make our bones weak and result in bone fractures, and which should be taken into account when making risk assessments and taking appropriate measures for treating patients.

The author is the director of the Department of Orthopaedics at the CK Birla Hospital®, Delhi. 

 

The opinions expressed in this article are those of the author and do not purport to reflect the opinions or views of THE WEEK.