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Link between diabetes and osteoporosis in the spotlight for UAE patients

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People with diabetes often have poorer bone quality and an increased risk of fractures.

According to the International Osteoporosis Foundation, one in three women and one in five men over 50 will suffer a fracture due to osteoporosis, and many of the risk factors for the disease are prevalent in the UAE.

These risk factors include diabetes, vitamin D deficiency, low mobility levels, premature menopause, long-term steroid use, smoking, being underweight, bone diseases, malabsorption of nutrients and other dietary issues such as calcium deficiency, and a family history of fractures.

According to Dr Sara Suliman, who is a consultant endocrinologist and diabetologist at Mubadala Healthcare’s Imperial College London Diabetes Centre (ICLDC), people with diabetes, particularly type 1 diabetes, often have poorer bone quality and an increased risk of fractures.

“Those with long-standing diabetes (>5yrs) and poor blood sugar control, and those who take insulin have the highest fracture risk,” she tells Omnia Health Insights. “It is suggested that they have altered bone quality due to the binding of glucose to collagen in bone causing weakness in the bone structure.”

She also highlights that type 1 diabetes is also associated with other autoimmune disorders that may cause osteoporosis such as coeliac disease, premature ovarian insufficiency or thyrotoxicosis.

“Some treatments for diabetes, such as pioglitazone may also cause osteoporosis, and people with diabetes can have complications such as blindness, neuropathy and hypoglycaemia that increase the chance of fractures if they get osteoporosis,” she adds.

Because advancing age and chronic conditions such as diabetes make people more vulnerable to the effects of COVID-19, many osteoporosis patients were previously encouraged not to leave the house for non-emergency care during the height of the pandemic. However, recently, ICLDC encouraged those patients with osteoporosis who are treated with denosumab to return to their normal injection schedules to ensure optimal bone health and avoid the risk of bone fractures.

Treatment

While osteoporosis causes bones to weaken and become more susceptible to fractures, treatment with denosumab prevents bone loss by blocking a specific receptor in the body to decrease bone breakdown. However, the treatment is intended to be lifelong and if it is stopped or delayed, bone health decreases rapidly, potentially increasing the risk of fractures significantly after a delay of just two months.

“It is important that these patients receive the injections every six months, or their bone mineral density – meaning the quality and quantity of bone – will deteriorate even more quickly than before treatment, falling to pre-treatment levels within just 12 months,” Dr Suliman says.

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