When it comes to the dangers of diabetes, people are often familiar with diabetic nephropathy, fundopathy, cardiovascular and cerebrovascular diseases, and diabetic foot disease. In fact, there is another chronic complication of diabetes that occurs in the skeletal system, which is very dangerous, has a high rate of disability and death, and is the main cause of long-term pain and dysfunction of the skeleton in diabetic patients. It is the diabetic osteoporosis that should not be underestimated. Osteoporosis is also not new to people. It occurs in middle-aged and elderly people, especially post-menopausal women, and statistics have been done abroad that 1/4 of women and 1/8 of men over the age of 50 suffer from osteoporosis. Diabetes and osteoporosis So what is the connection between diabetes and osteoporosis? What is the difference between diabetic osteoporosis and ordinary osteoporosis? Let’s start with osteoporosis. Our bone tissue consists of two parts: the bone matrix, formed by proteins such as collagen, and bone salts, which are mainly calcium and phosphorus compounds. Bone salts are deposited on the bone matrix to form bone. Strong and hard bones are not static, but always maintain a dynamic balance of “bone formation” and “bone resorption”, from this perspective, we can say that our bones are “new” every day. From this perspective, we can say that our bones are “new” every day. However, once this balance is disturbed, various types of bone diseases may occur. For example, when the rate of “bone formation” does not keep up with the rate of “bone resorption”, the amount of bone in the bones decreases and the microstructure of the bone tissue is destroyed, causing osteoporosis, which increases the risk of bone fragility and fracture. Primary osteoporosis is often caused by the reduced bone formation capacity of the elderly or the increased bone resorption due to the decrease in estrogen levels in postmenopausal women, while the diabetic osteoporosis introduced in this article is a secondary one. How does diabetes mellitus cause osteoporosis? As the most common endocrine metabolic disease today, diabetes mellitus not only has disorders of sugar, protein and fat metabolism, but also causes calcium loss and abnormal bone metabolism. The typical symptom of diabetes is excessive drinking and urination, and a large amount of calcium and phosphorus minerals will be eliminated from the body with urine. If there is a lack of necessary calcium supplementation, it will cause a “negative calcium balance” in patients, which will lead to a series of hormonal level changes and enhance osteolysis, eventually leading to bone decalcification and osteoporosis. In addition, the active vitamin D level in diabetic patients is often low, which affects the absorption of calcium, phosphorus and other minerals in the intestine, and the decreased insulin sensitivity characteristic of type 2 diabetes adds to the destruction of bones, which affects normal protein metabolism and reduces bone matrix synthesis. All of these factors combined eventually lead to a reduction in bone matrix, destruction of bone trabeculae and reduced bone density in diabetic patients, making them at high risk for osteoporosis attacks. Diabetic osteoporosis Diabetic osteoporosis also differs greatly from primary osteoporosis in terms of disease manifestations, treatments and treatment outcomes due to the different mechanisms that lead to disease onset. The clinical manifestations of diabetic osteoporosis have the characteristics of both diabetes and osteoporosis, and are mostly seen in elderly diabetic patients with a long history of the disease. In the early stage of the disease, patients often have no obvious symptoms, but as the disease progresses, they will gradually develop low back pain, hunchback deformity, short height, weakness of limbs and calf cramps. In severe cases, spontaneous fractures may occur or fractures may occur under minor external forces (such as coughing, sneezing, bending, weight-bearing, crushing, falling, etc.), and fracture sites are most common in the thoracolumbar spine, hip and wrist. In the treatment of diabetic osteoporosis, the treatment of diabetes must also be given top priority. As the saying goes, “if the skin does not exist, the hair will not be attached”, the diabetic condition is controlled and stabilized, and the major cause of osteoporosis is removed. Generally speaking, the content of calcium, magnesium and zinc in regular diabetic recipes is significantly insufficient. Therefore, diabetic patients should maintain a balanced nutrition, not over diet, and should usually eat more calcium-rich foods, such as milk and other dairy products, calcium-rich vegetables, beans, etc. This is the prerequisite and basis for the prevention, delay and treatment of osteoporosis. Exercise is also important. Regular aerobic exercise, such as jogging, brisk walking, swimming, etc., can not only help diabetics control blood sugar and weight, but also help strengthen bones and prevent osteoporosis. In addition, sufficient sunlight can promote the synthesis of more active vitamin D in the skin and promote the absorption of calcium in the intestine, so it is recommended that diabetics have at least half an hour of sunlight every day. In addition to this, diabetics must also quit all habits that are detrimental to bone health, such as smoking, alcohol abuse, heavy coffee and strong tea consumption. Good news and bad news Diabetes can cause and aggravate osteoporosis, which is bad news; the good news is that, compared with the slow onset, long course and insignificant effect of primary osteoporosis treatment, diabetic osteoporosis has a faster onset, relatively short course and more obvious effect after effective treatment. Of course, the actual situation is always much more complicated than the theoretical one. Since many diabetic patients have primary causes of osteoporosis such as increasing age, low activity, reduced sex hormone levels, and genetics at the same time. Therefore, in clinical work, diabetic osteoporosis and primary osteoporosis often appear side by side as well, and it is sometimes difficult to distinguish them strictly. However, these difficulties can be left to doctors to study slowly, for patients, they only need to understand: diabetes, to be treated; osteoporosis, more to be treated. As diabetics, in addition to controlling blood sugar, we need to care about our kidneys, eyes, cardiovascular and cerebrovascular, lower limb podiatry, and don’t forget to care about our increasingly lax bones.