Diabetes is a disease characterized by a disruption of sugar metabolism in the body. People with diabetes have abnormally high levels of sugar in their blood and urine, and this “sweet” liquid can cause great harm to human health. Therefore, people compare diabetes to the “sweet killer”. Osteoporosis is a systemic bone disease characterized by abnormal bone metabolism, resulting in changes in the structure and quality of the human skeleton, which is prone to brittle fractures. Because of the slow onset of osteoporosis and the seriousness of the damage, it is called the “hidden killer”. When the “killer” wears a “gentle” veneer, the threat to people is even greater. The incidence of fragility fractures is significantly higher in diabetic patients than in people of the same sex and age group due to the characteristic of “brittle bones”, which has a great impact on public health and consumes a lot of medical resources.
Why are diabetic patients prone to fragility fractures?
First, diabetic patients have high levels of blood glucose, which causes abnormalities in calcium and phosphorus metabolism in the body. Specifically, the diuretic condition of diabetic patients with high osmolality causes a large amount of glucose to be excreted from the urine, and mineral elements such as calcium, phosphorus and magnesium are also excreted from the blood. In the long run, this will put the body in a state of calcium and phosphorus deficiency. Calcium, phosphorus, magnesium and other minerals are the cornerstone of the formation of human bones, is the construction of the human body “bone building” of “raw materials”. Lack of calcium and phosphorus of the human body to build the “bone building” is bound to be “tofu dregs project”. And the “tofu-dreg project” by the construction of the “skeletal building” quality is worrying, easy to damage, which is the reason for the “fragility fracture” occurs. At the same time, low calcium and phosphorus in the blood will stimulate the parathyroid glands located in the neck to produce parathyroid hormone. Parathyroid hormone is like dilute sulfuric acid, which has a chronic decomposition and corrosion effect on bones, and in the long run, the bones will produce “holes” of different sizes, and the strength will be significantly reduced. When people walk and fall, limb sprains, etc., these abnormal “external forces” will act on the “cave”, so that the “top of the cave” sinks, and the “wall” collapses. The “cave wall” will collapse and produce brittle fractures. Therefore, unlike fractures caused by high energy such as car accidents, impacts and falls, fragility fractures are characterized by low energy and insidiousness, and are a unique type of fracture for patients with osteoporosis.
Secondly, one of the common complications in diabetic patients is systemic vascular damage, and the kidney is one of the most abundant and concentrated organs in the body, so diabetic patients are often accompanied by kidney function damage. Under normal circumstances, vitamin D is required to maintain bone metabolism; otherwise, calcium in the blood cannot be effectively deposited in the bones. Vitamin D needs to be “activated” by a chemical in the kidneys called hydroxylase. If a patient’s kidney function is impaired, the activity of hydroxylase will be reduced, which prevents vitamin D from being fully utilized by the body, thus affecting the absorption and utilization of calcium. Calcium-deficient bones are like buildings lacking steel and cement, their strength is greatly reduced and they are vulnerable to brittle fractures.
The ability of the human skeleton to support the body and perform its motor and physiological functions is closely related to its cells called “osteoblasts”. Osteoblasts are responsible for the process of “regeneration” and “strengthening” of bones. A protein called hepatic insulin receptor is present on the surface of osteoblasts and is involved in the process of building bones. The relatively low insulin secretion in diabetic patients affects the function of the insulin receptor, which is like tying the hands of the construction workers and affects the construction of the “skeletal building”, and this is one of the reasons for the higher incidence of fragility fractures in diabetic patients.
In addition, the age, gender, race, occupation, and diet of diabetic patients are also associated with the occurrence of fragility fractures. Statistics show that the incidence of fragility fractures is higher in diabetic patients who are elderly, female, vegetarians, brain workers, and those who are alcoholics and smokers than in other populations. It has been observed that the incidence of fractures due to diabetes is significantly higher in Asian populations than in European and American populations. Experts have concluded that “herbivory (grain-based diet)” is one of the major reasons why the incidence of diabetic osteoporosis and fragility fractures is higher in Asians than in Westerners who are “meat-eaters (animal protein-based diet)”. In conclusion, it is an indisputable fact that the incidence of fractures in diabetic patients is higher, and the “sweet honey” leads to “brittle bones”.
What parts of the fragility fracture can occur in diabetic patients?
1, vertebral fracture: the spine, including the cervical, thoracic, lumbar and sacrococcygeal vertebrae, is the “main bone” of the human body, is the basis for human movement and the normal function of organs and organs, for this reason the spine bears most of the body’s gravity and load. When diabetes causes osteoporosis, the most stressed vertebrae become decalcified and the bone strength decreases, which is a pathological change of “bone fragility”. If the vertebrae are then subjected to external forces, the overburdened vertebrae will be “crushed” and deformed, which is clinically referred to as a “vertebral compression fracture”. Vertebral compression fracture is common in elderly diabetic patients, the “violence” that causes vertebral compression fracture is sometimes not large, and even the patient himself does not notice, but the fracture has arrived quietly.
2, hip fractures: hip fractures are divided into two major categories: femoral neck fractures and femoral intertrochanteric fractures. The human hip joint is characterized by a large bearing force (almost all the gravity of human movement) and a weak local structure, which is a typical anatomical structure of “a small horse pulling a big car”. In diabetic osteoporosis, the brittleness of the bones increases, the strength decreases, and the weight-bearing capacity decreases. If there are external forces (such as falls and sprains of the lower limbs), it is easy to cause fractures of the hip joint.
3. Shoulder fracture: The shoulder joint is the joint with the greatest amount of human activity and movement, and is therefore the most vulnerable to injury. As the bones of diabetic patients are in a lax state, if they fall, the shoulder joint is subjected to direct external force, which can easily cause fracture.
4. Wrist fracture: The typical and common wrist fracture occurs at the distal end of the radius, also known as “distal radius fracture” or “Cline’s fracture”. Since the bone of the wrist joint is relatively loose and the bone strength is poor, if the patient falls (the elderly are more likely to fall) and supports the ground with the hand, the violence is transmitted to the wrist through the hand, which may cause a wrist fracture.
The above four fractures are common types of fractures in patients with diabetic osteoporosis, but fractures can also occur in other parts of the body due to the presence of osteoporosis, only the incidence is lower. Therefore, in addition to actively treating diabetes, diabetic patients should also pay attention to treating osteoporosis and, more importantly, to preventing fractures caused by osteoporosis.
How to prevent fragility fracture in diabetic patients?
1. Diabetes should be treated actively. For patients in the early stage of diabetes, or those with only reduced glucose tolerance, blood sugar can be controlled under the guidance of a doctor, and blood sugar levels can be controlled through diet regulation, exercise and weight reduction, supplemented by the use of hypoglycemic drugs or insulin if necessary to achieve the purpose of blood sugar control. Diabetic patients and people with abnormal blood sugar should always measure their own blood sugar values to have a good idea, and use it to guide their diet, exercise and treatment, in order to control blood sugar in the normal or near-normal range, which is the most fundamental way to prevent osteoporosis, avoid “bone brittle” and reduce the incidence of fractures.
2, correct calcium supplementation. Calcium supplementation is one of the basic methods to treat and prevent osteoporosis. The main methods of calcium supplementation are food (such as eating fish and shrimp, drinking milk and calcium-rich food) and medication (such as oral calcium supplements or calcium-containing nutrients, etc.). When choosing calcium supplements, you should consult a specialist to choose the right dose, dosage form and route of administration, never the higher the calcium content the better, nor the more expensive the better, nor the more famous the better. It is important to choose 1-2 medications or supplements that are suitable for you and take them correctly for a long time. While taking calcium supplements, vitamin D preparations should be applied at the same time, because only with the participation of vitamin D can calcium ions be deposited in the bones, otherwise they will only be excreted from the urine and feces, which will not achieve the purpose of treating and preventing osteoporosis and reducing the incidence of fractures. In addition to the application of appropriate medications, the source of vitamin D, patients get more sunlight and do more outdoor activities is also a good way to effectively increase the supply and intake of vitamin D. This is because there is a large amount of vitamin D “raw material” in the human skin, and these substances can only be transformed into active vitamin D and used by the body under the action of ultraviolet light.
3. Drug treatment. The use of anti-osteoporosis drugs has a certain role in reducing the occurrence of fractures, but the drugs should be used under the guidance of a specialist to prevent the toxic side effects of drugs on the human body. Commonly used anti-osteoporosis drugs include sex hormones, bisphosphonates, osteoclast inhibitors, calcium agents, etc.
4.Actively participate in sports. Physical exercise, also known as exercise therapy, is an effective way to prevent osteoporosis and reduce “fragility fractures”. Through the body exercise, on the one hand, can consume part of the energy to achieve the purpose of lowering blood sugar, on the other hand, can prevent
”Bone fragility”, increase the strength of the bone. Research has proven that when the bones are under “load”, the loss of bone calcium is the least, and the calcium ions in the blood are gathered to the bones the fastest. Therefore, exercise can strengthen bones and prevent osteoporosis, thus reducing the occurrence of fragility fractures.
The following are a few easy-to-learn exercise methods. Exercise methods, time and intensity vary from place to place and from person to person.
1.Walk, calcium is not lost
Studies have shown that the longitudinal pressure on the bones is particularly important in reducing the loss of bone calcium, so exercise therapy should focus on applying pressure to the bones in the longitudinal direction. The bones of the human leg are generally perpendicular to the ground, therefore, the force generated by the exercise is also best to be basically perpendicular to the ground, the best therapeutic effect. Therefore, walking is one of the best ways to prevent and treat “brittle bones”. The reason is that whether stepping or walking, the body’s forces are generally perpendicular to the ground and are transmitted along the bones of the lower extremities. As the lower limb bones are stimulated by the pressure from the vertical direction, can effectively relieve the loss of bone calcium.
2.Jumping has a healing effect
The pressure generated by the weight of the person when jumping will be transmitted down the spine (cervical vertebrae, thoracic vertebrae, lumbar vertebrae) and both lower limbs, so that the bones are stressed vertically, which is conducive to the prevention and treatment of osteoporosis. For people in poor health, jumping should be done according to their strength. When jumping, prevent falls by holding walls, trees, furniture and other measures. For middle-aged and elderly people who are in good physical condition, learning and practicing dance, square dancing, etc. are good choices.
3.Tiptoe is good for the spine
Tiptoe exercise is good for increasing the pressure on the spine and lower limb bones, thus contributing to reducing the loss of bone calcium. Especially for people with kyphosis (commonly known as hunchback deformity) caused by osteoporosis, tiptoeing can increase the density of vertebral bone tissue in the spine. People stand steadily, breathe deeply and then slowly lift their heels up and support their bodies with the forefoot, maintaining them for 3-5 seconds and then lowering their heels, and repeat the exercise to gradually increase the time and frequency of tiptoeing. Some people can also carry several kilograms of weights with both hands to complete the tiptoe movement, the effect is better.
4.Stretch your legs and get sick gradually
Doing stirrups, with the strength of the lower limb muscles, increases the movement and pressure of the bones to prevent and alleviate the purpose of “bone fragility”. The patient is in supine position, with one lower limb flexed at the hip and knee, so that the thigh is as close to the chest as possible. Once in position, the patient stretches the leg in a forward motion to straighten the lower extremity quickly. Alternatively, both lower limbs can do the stirring exercise at the same time. The number of stirrups per exercise should be determined according to the patient’s physical condition, but care should be taken to prevent muscle damage during the stirrups.
5, climbing high places, to moderate
The purpose of ascending exercise is the same as the other exercises mentioned above, which are to increase the pressure or load on the bones of the spine and both lower limbs and reduce the loss of bone calcium. If the patient is physically able to do so, he or she can gradually perform ascent exercises. The ascent exercise includes stair climbing, mountain climbing, or ascent exercise indoors with artificial stair equipment. The principle of gradual progress should be noted when completing the ascent exercise, and attention should be paid to prevent falls and ankle injuries.
If we compare “sweet honey” to “skin”, “brittle bones” is “hair”. “If we compare the treatment of diabetes to the “outline”, the prevention of brittle fracture is the “eye”. “Therefore, effective blood glucose control is the golden key to prevent fragility fracture in diabetic patients.