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TPR Lifeline: Diabetes And Brittle Bones

Wendy Rigby
Texas Public Radio
Osteoporotic bones often look like the model on the left. In diabetics, their bones can look normal like the model on the right. In actuality, though, they may be brittle.

Diabetics are at risk of many serious side effects like heart trouble, nerve damage, kidney failure, blindness and amputations. Now, there’s growing evidence the disease also puts people at greater risk of bone fractures. In today’s TPR Lifeline, Bioscience-Medicine reporter Wendy Rigby talks to Dr. Ajeya Joshi of South Texas Spinal Clinic about the link between diabetes and brittle bones. Here is a transcript of the interview.


Rigby: This will be news to many people – that having diabetes puts you at greater risk of brittle bones. Dr. Joshi, what’s happening here to increase the risk of osteoporosis in type one and type two diabetics?

Credit Wendy Rigby / Texas Public Radio
Texas Public Radio
Ajeya Joshi, MD, is a San Antonio orthopedic spine surgeon.


Joshi: Diabetes can affect practically every organ in the body. But now we know that it impacts bone. And if you think about diabetes as having too much sugar floating around in your bloodstream, well the bones have blood flowing to them. And so that sugar lands inside the bone matrix and corrodes it, if you will. So it’s not that you necessarily have less bone, but the bone that you do have is not of a good quality.

Rigby: So even if you get a normal bone scan, if you have diabetes you might be more at risk than someone without diabetes of fracture.

Joshi: That’s absolutely right. So we know that for diabetics we have to interpret their bone scans differently. And that’s an understanding that we didn’t necessarily routinely have five or ten years ago. So they are at risk at fracturing at bone scores that would be considered normal for other people.

Rigby: And what part of the body is most affected?

Credit Wendy Rigby / Texas Public Radio
Texas Public Radio
Bone scans for diabetics can appear normal even if they are at greater risk of fractures, according to Joshi.


Joshi: You could see fractures like a wrist fracture in a 50-year-old female tennis player that might have fallen on the tennis court. Vertebral fractures are common, of the spinal column if you will in many of us. An important metric to follow in any medical office is how tall is our adult patient. And you see people losing height over time and that might be very important. And the final area that’s common are shoulders and hips as we get into our seventies and eighties.

Rigby: What could you do for someone who’s diabetic if you knew or you could tell that they were developing this side effect from the disease?

Joshi: We need to now recalibrate or adjust how we think of diabetics and think of an earlier threshold for helping them with their bone density studies when they’re low. For our diabetic patients whether it’s avoiding vascular problems like heart disease or stroke or dialysis from kidney failure, controlling your sugars is important for one more reason.

Credit Wendy Rigby / Texas Public Radio
Texas Public Radio
Vertebral fractures are a common consequence of osteoporosis.


Rigby: This paper you recently published used data from University Health System. Where was it published and what audience were you trying to reach with this particular message?

Joshi: We were excited to be involved in this research which was published in the Journal of Immigrant and Minority Health.

Rigby: What did you find in particular about Hispanic diabetics?

Joshi: Being both diabetic and Hispanic raised the risk of fracture above the population that was diabetic but not Hispanic by one-and-a-half to two times. And that makes us say we’ve got to pay particular attention to these patients, communicate with them, educate them and their primary doctors and in the future, dedicate more attention and resources to understanding the background behind that.

Rigby: So people who are listening to this and saying “I might fall into that category” may wonder “what happens if I have this? Is there something that can be done for me so that I can keep my bones strong?”

Joshi: I would say that if you fall into a category where you’re diabetic or Hispanic and diabetic, the key takeaways are being aware and being very attuned to lifestyle, exercise, sugar control and knowing that this is one more reason to control your sugars. And weight-bearing exercise is incredibly important. So there are factors like exercise which the bones love. Our bones being loaded. So the astronauts in space lose bone mass because there’s no gravity. So walking is a great and important way to help your bone mass.

Rigby: Do you think more research will be done on this topic?

Joshi: I expect that we will be seeing a lot more attention devoted to this area in the years to come.

Rigby: Dr. Joshi of the South Texas Spinal Clinic, thank you so much for joining us.

Joshi: It’s a pleasure to be here. Thank you.

Wendy Rigby is a San Antonio native who has worked as a journalist for more than 25 years. She spent two decades at KENS-TV covering health and medical news. Now, she brings her considerable background, experience and passion to Texas Public Radio.