Type 1 diabetes and bone healing: How to maintain healthy bones

The connection between diabetes and bone healing definitely deserves more attention.

Although people living with type 1 diabetes (t1d) are at a higher risk for fractures and bone conditions, potential problems in our bones are often overlooked because we're so focused on managing possible complications! As with other aspects of the condition, a little knowledge can go a long way toward addressing — and preventing — challenges.

If you live with t1d, here's what you need to know about the risks associated with bone problems and how to keep your bones healthy.

T1D leads to a higher risk of bone problems

According to the National Institute of Diabetes and Digestive and Kidney Diseases, people with t1d are seven times more likely to experience hip fractures than people without diabetes. In addition to weakened bone health, diabetes also makes people more susceptible to bone conditions, including osteoporosis, which is characterized by reduced bone strength and lower bone mass.

Of course, many people living with t1d have healthy bones and participate in high-impact activities — but when compared to the general population, our bones tend to be more fragile. Studies have shown that t1d is associated with decreased bone density. People with the condition are more prone to losing bone cells and less able to replace them with new ones, according to Shannon Wallet, an immunologist at the University of Florida.

Scientists don't know all the reasons why diabetes increases the risk of bone problems, but high blood glucose may be partly responsible for weaker bones. Bone material quality tends to be worse in people who have poor blood sugar management, says Sundeep Khosla, a bone loss researcher at the Mayo Clinic.

Keep that in mind if you need more incentives to manage your blood sugar levels or to use advanced diabetes technology like insulin pumps and continuous glucose monitors (CGMs).

Bone tests can help spot issues

Currently, there are no recommendations on the best time for people with t1d to get their bones tested — doctors typically make that determination based on each patient's symptoms and risk factors. One of the most important available tests, a dual-energy X-ray absorptiometry scan (also known as DXA or DEXA), measures bone density.

Derek LeRoith, a professor of medicine at Mt. Sinai in New York City, has advised individuals in the t1d community to talk with their doctors about undergoing a DEXA scan, as they'll be able to provide specific guidance and a potential timeframe.

3 tips for maintaining healthy bones

Thankfully, people living with diabetes can use a number of strategies to keep their bones strong and healthy. Here are three actions that can help you maintain bone health and avoid complications:

1. Exercise to keep your bones healthy. Like muscles, bones become stronger through exercise. Staying fit can also help you maintain balance and coordination, reducing the risks of falls and fractured limbs.

Bone-building exercises include weight-bearing activities that force you to work against gravity, such as walking, hiking, jogging, climbing stairs, or playing tennis. Weight resistance exercises — like lifting weights — can also help you to maintain healthy, strong bones.

2. Stay on top of blood sugar management. Better blood glucose management helps to reduce the chances of fractures and other bone problems in people with diabetes. People with high blood glucose may have higher fracture risks. According to Ann Schwartz, an epidemiologist at the University of California–San Francisco, poor glycemic control increases the risk of fracture.

To reduce the risks of bone problems, it's a good idea to use advanced blood sugar monitoring technologies, including CGMs and fingerstick testing supplies.

3. Enrich your diet with calcium and vitamin D. Foods rich in calcium and vitamin D are another tool to help you maintain healthy bones. Nutritionists at the Beth Israel Deaconess Medical Center recommend calcium-fortified cereals, salmon, dark leafy greens and vegetables, yogurt, and milk alternatives (like almond, soy, cashew, or hemp milk).

Talk to your doctor about bone health

If you have concerns about type 1 diabetes and bone healing, don't wait for your doctor to bring up this topic. Be proactive and share any questions you have about bone health with your healthcare provider.

Are you looking for more information to help you navigate life with diabetes? Check out the Health Insights blog for actionable advice and practical suggestions for people with the condition.