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Posted by Specialist I Vo Khac Khoi Nguyen - Orthopedic Trauma Doctor - General Surgery Department - Vinmec Central Park International General Hospital.
Diabetes reduces the strength of the musculoskeletal system, increasing the risk of falls. However, the link between diabetes and skeletal health has not been given enough attention. This leads to a challenge in the treatment of osteoporosis in diabetics.
1. General principles in the treatment of osteoporosis in people with diabetes
Diabetes is a common metabolic disorder worldwide. Diabetes is strongly associated with osteoporosis and fracture risk. In patients with type 2 diabetes, the risk of osteoporosis fractures is 1.5 times higher than in nondiabetics.
General principles in the treatment of diabetic osteoporosis include good glycemic control, prevention of hypoglycemia and falls, and exercise programs to improve muscle and bone strength in general. . In addition, calcium and vitamin D supplementation is also very important in the treatment of osteoporosis.
2. Good blood sugar control
HbA1c tăng cao ở bệnh nhân đái tháo đường làm tăng nguy cơ gãy xương
High blood sugar levels due to poor diabetes control, many years of diabetes increase the risk of bone fractures. Blood sugar control includes medications, diet, and exercise. Aggressive measures of glycemic control were not significantly associated with risk of fractures or falls compared with standard therapy.
A study examining the association between HbA1c (a value indicating blood sugar control) and the risk of hospitalization for fracture had a median follow-up of 20 years. Those with an HbA1c ≥8% had a 63% higher risk of hospitalization for a fracture than those with an HbA1c less than 8%. Type 2 diabetes patients with HbA1c >7.5% had a 62% increased risk of fracture compared with those with HbA1c less than 7.5%.
In patients with type 1 diabetes, the risk of fracture also increases with elevated HbA1c. A 1% increase in HbA1c increases the risk of fracture by 5% in men and 11% in women with type 1 diabetes.
3. Prevention of falls and hypoglycemia
Low blood sugar easily leads to falls. Falls are an important event that causes fractures in people with diabetes. In the treatment of osteoporosis, we need to determine the high risk of falling in the following cases:
The patient has had episodes of hypoglycemia due to medication (mainly insulin ). Frequent nocturia (notice in people with complications of diabetic kidney disease). Poor vision due to retinopathy or cataracts. Poor balance due to neuropathy, foot ulcers, or foot amputation in diabetics. Orthostatic hypotension (due to autonomic neuropathy of the heart). Limited joint mobility due to bone and joint disease
Hạ đường huyết dễ dẫn đến té ngã gây gãy xương ở người đái tháo đường
Poor vision due to retinopathy or cataracts. Poor balance due to neuropathy, foot ulcers, or foot amputation in diabetics. Orthostatic hypotension (due to autonomic neuropathy of the heart). Limited joint mobility due to bone and joint disease
4. Active treatment of osteoporosis
Calcium and vitamin D are important materials in the process of bone formation. Doctors recommend that all adults take a vitamin D supplement of 600 IU/day between the ages of 51-70 and 800 IU/day for those over 70 years of age. The recommended dose for calcium is 1200mg elemental calcium for all women over 50 years old and men over 70 years old; 1000mg elemental calcium for men aged 51-70.
Currently, there are no specific guidelines for initiating anti-osteoporotic drugs in diabetes. Bisphosphonates are the first and most common choices. Denosumab may be used in people with impaired kidney function.
In summary, patients with diabetes have a higher risk of osteoporosis. In addition to treatment with anti-osteoporosis drugs, measures of good glycemic control, prevention of hypoglycemia and falls, exercise programs supplemented with calcium and vitamin D are the cornerstones of osteoporosis treatment in patients with osteoporosis. diabetics.
Vinmec International General Hospital always deploys a screening package for diabetes and dyslipidemia to help detect pre-diabetes early, accurately classify diabetes type, develop a nutritional regimen, according to the guidelines. Monitor to reduce the risk and complications caused by diabetes.
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Diagnostic criteria for diabetes and pre-diabetes What are the complications of diabetes? How does diabetes cause osteoporosis?
