An important cause of diabetes is the absolute or relative lack of insulin in the body, which has the function of promoting bone formation, promoting protein and bone matrix synthesis, and maintaining normal calcium and phosphorus metabolism. Therefore, when insulin is deficient, disorders of calcium and phosphorus metabolism and protein metabolism can occur in the body, leading to a decrease in the mineral content of bones, a decrease in bone density and a decrease in vitamin synthesis, resulting in osteoporosis. Treatment of diabetes-induced osteoporosis should start from the following aspects.
1. Control of blood sugar.
Whether type I diabetes (insulin deficiency) or type II diabetes (the body is insensitive to insulin), the main methods to control abnormally high blood sugar are: control of diet, exercise therapy, drug therapy, insulin use. Especially for type II and obese patients, they should be supplemented with pharmacotherapy under the premise of diet control, while type I diabetic patients are mainly for insulin supplementation. Glucose-lowering drugs or insulin should be used under the guidance of a doctor. After diabetes is controlled, osteoporosis and bone pain can be reduced or alleviated. The commonly used drugs are.
(1) Toluenesulfonylurea
Other name】D-860
Usage】Orally: 0.5g per dose, 2-4 times a day, and the dosage should be increased or decreased according to the patient’s blood sugar level.
Precautions] This product can cause jaundice and liver function damage, so the liver and kidney insufficiency is prohibited.
(2) Glibenclamide
Other Name】Ubiquinol
Usage】Orally: take 2.5-10 mg orally once before breakfast; or start with 2.5 mg orally daily, then gradually increase the dosage according to the change of blood sugar (up to 15 mg daily), and reduce to maintenance dosage of 2.5-5 mg daily after the efficacy appears.
Precautions] This product should be used in small doses to start with. When the 1 day oral dose exceeds 10 mg, it should be divided into 2 doses in the morning and evening.
(3) Gliquidone
Other Name】Glucophage
Usage】Orally: 30 mg each time before breakfast or breakfast and lunch (or before dinner). It can also be taken 15 mg before each of the three meals.
Precautions] The dosage should be adjusted about 1 week after taking the drug. The maximum daily oral dose should not exceed 180 mg.
(4) Phenylephrine
Other names】Glucagon
Usage】Orally: Adults start with 25 mg per oral dose, twice daily, before meals. After a few days, 25 mg can be increased, but the maximum daily dose should not exceed 75 mg.
Precautions】The application of this product should prevent lactic acidemia and should prevent hypoglycemia. It is contraindicated in heart and respiratory failure, hepatic and renal insufficiency, ketoacidosis complicated by diabetes, acute infection, pregnant and lactating women.
(5) Metformin
Other names]: Metformin, hypoglycemic tablets, Meticam, Gevalt
Usage】Orally: Take 0.25g orally at the beginning, 2-3 times daily, and then adjust the dose according to the condition.
Precautions】Dosing with meals can reduce gastrointestinal reactions.
(6) Reglanet
Other names】Norvon
Usage】To be taken orally within 30 minutes before meal. The recommended starting dose is 0.5 mg, the maximum recommended single-use dose is 4 mg, and the maximum daily dose is less than 16 mg.
Precautions】Patients with type I diabetes, patients with diabetic acidosis with or without coma, pregnant and lactating women, and those with hepatic and renal insufficiency are prohibited. The ability to drive or operate machinery may be affected after taking the drug and should be noted.
(7) Naglinide
Other names】Tangli
Usage】120 mg orally before meals. The dose can be adjusted according to the value of glycosylated hemoglobin measurement.
Precautions] Patients with mild hepatic disease and renal impairment do not need to adjust the dose, but use with caution in patients with severe hepatic disease. The rest is the same as “Reglanet”.
(8) Acarbose
Other names]: Bystolic
Usage】Initiate 25 mg orally 3 times a day, and increase the dose to 50 mg 3 times a day after 6-8 weeks. If necessary, the dose may be increased to 100 mg per dose, 3 times daily. The total daily dose should not exceed 300 mg.
Caution】It should be swallowed immediately before meal or chewed at the same time with the first bite of main food. If hypoglycemic reaction occurs, drink a small amount of sugar water to correct hypoglycemia. Pregnant and lactating women, those with a history of enteritis, intestinal obstruction, or abdominal surgery are prohibited.
(9) Voglibose
Other Name】Bexin
Usage】Orally: 200 micrograms each time, 3 times a day, before meals. The dose can be increased to 300 micrograms per dose according to the condition.
Precautions】Patients with severe hepatic steatosis should pay attention to bowel movements when using the drug, and if abnormalities are found, the drug should be discontinued immediately.
(10) Epastat
Usage】Orally: 50 mg once orally before meals, 3 times daily.
Precautions】If the efficacy is not good after 12 weeks of use, the treatment should be changed to other drugs. Pregnant and lactating women are prohibited. Use with caution in patients with hepatic or renal insufficiency.
(11) Rosiglitazone
Other names]: Vindial
Usage】Solo-administration: The initial dose is 4 mg per day, divided into 1-2 oral doses, and can be increased to 8 mg per day after 12 weeks if the blood glucose decline is not satisfactory. If combined with metformin, the initial dose is 4 mg daily, and may be increased to 8 mg daily if the blood glucose drop is unsatisfactory after 12 weeks. In combination with sulfonylureas (toluenesulfonylurea, glibenclamide, etc.), the daily dose is 2-4 mg, divided into 1-2 oral doses.
Precautions] Contraindicated in patients with cardiac insufficiency, pregnant and lactating women, type I diabetes or diabetic ketoacidosis. Use with caution in patients with edema.
(12) Pioglitazone
Other names】Riton
Usage】Solo medication: The initial dose is 15-30 mg once daily, if the efficacy is not good, it can be increased to 45 mg daily. When used in combination with sulfonylureas, the product is 15-30 mg once daily and the dose of sulfonylureas remains unchanged. When hypoglycemia occurs, the dosage of sulfonylurea should be reduced. When combined with metformin, this product is 15-30 mg once a day, and the dose of metformin remains unchanged. When combined with insulin, the dosage of insulin is unchanged, and the dosage of insulin can be reduced when hypoglycemia occurs. The maximum recommended single dosage of this product is less than 45 mg per day, and the combined dosage does not exceed 30 mg per day.
Precautions】Dosing is not related to food intake. Pregnant women, lactating women, and those with cardiac insufficiency (class III-IV) are prohibited.
2.Increase nutrition and rationalize dietary structure: follow the requirements of diabetic treatment.
3.Adjust the amount of exercise: appropriate physical exercise to reduce weight.
4.Use calcium supplements: daily oral calcium supplementation is 800 mg – 1200 mg.
5.Supplementation of vitamin D and vitamin C: oral alfa osteopontin can be taken at 1-4 micrograms each time, once a day. You can also take oral ossifying triol (rocalciferol) 0.25-0.5 mcg daily. Oral vitamin C 0.5-1 gram.
6. Estrogen replacement therapy can be used in the elderly: e.g., use of hexestrol at 0.5 mg 1-2 times daily.