In women, menopause is the time when the female hormones namely Estrogen and progesterone decreases sharply secondary to the aging of the ovaries. This sudden fall in sex hormones causes abrupt changes in the function of many systems of the body. Men, on the other hand, have a gradual fall in the testosterone and andropause is generally slow and so unnoticed.
Sex hormones have a tremendous influence on bone formation. Bone loss or Osteoporosis can happen secondary to a decrease in the bone material or matrix which has many proteins and collagen forming the skeleton of bony architecture. It could also mean a decrease in bone mineralization namely calcium, phosphate, etc.
When sex hormones decrease abruptly, bone formation and mineralization suffer markedly. This weakens bones leading to readjustments in plantar pressures and susceptibility to falls and fractures.
Diabetes by itself weakens bone. In type 1 diabetes, insulin deficiency recruits fewer IGF receptors decreasing the bone material formation and diminished bone mineral density. In type 2 diabetes, bone mineral density increases paradoxically but the bone formation is of very poor quality.
The cortical bone has more pores which hamper weight bearing capacity causing tearing and shearing of the layers. The inner bone is also known as Trabecular bone is less dense and soft due to malformation of cross-linking of proteins secondary to glycosylation.
A DEXA (Dual Energy X-Ray Absorptiometry) Scan detects bone mineral density. Assessment will be looking at the T score and Z score.
A T score of more than -1 is normal. Between -1 and – 2.5, the bone is weak or Osteogenic and <-2.5 is the T score, the bone is already Osteoporotic.
When there are Diabetes and menopause there is double trouble and so the tendency to falling down increases. Diabetic patients, in addition, have vision loss due to retinopathy and imbalance of gait and foot problems secondary to neuropathy and diabetic foot. So falls are common. Falls give rise to fractures and confine patients to bed disturbing metabolic control.
How can we avoid fractures and strengthen our bones:
It is important to keep sugars in control to keep, blood vessels without obstruction, nerves intact and prevent bone loss and diabetic foot.
Vitamin D deficiency treatment the bone by depositing calcium and strengthening it. We need to check Vitamin D levels to correct deficiency if present. But a maintenance dose for prevention will be advised by your doctor. Postmenopausal women should take enough calcium as advised. Some also need hormones (Hormone Replacement Therapy) is advised. There are other modern therapies like Alendronate to be taken once a week or Denosumab once every six months.
Physical activity on a daily basis, both upper and lower extremities can stimulate bones to work better; appropriate diet for diabetic control and prevention of weight gain gives good bone health. Weight loss can relieve the workload on long bones.
Above all a positive attitude, good sleep and effective communication help.
Strong bones strengthen life.
MD FICP FACP FACE (USA) PGDDM (UK)
Fellowship In Diabetes (India)
Senior Consultant, Diabetes & Thyroid Specialities Center