Palm Beach Diabetes and Endocrine Specialist held their third Symposium for Continuing Medical Education to the Palm Beach Health Practitioners community on Saturday September 28, 2019. This year’s title was “Endocrinology and Diabetes: Practical approaches in Patient Management for the Primary Care Physician.” My lecture was about the evaluation and treatment of osteoporosis and I would like to share some of the findings that I came upon while preparing for my conference.
After all these years taking care of patients with diabetes, I had forgotten, or perhaps, I was never really aware, that patients with diabetes are at greater risk for fragility fractures as compared to the general population. In fact, this is true even when they don’t fit the typical profile that you would expect: the fragile, elderly, thin, Caucasian female. No, patients with diabetes are not thin and even then- they are at higher risk for fractures- even when their bone mineral density appears normal or even high.
Diabetes, especially when it is not well controlled, damages the microarchitecture of the bones, making them more fragile and thus, prone to break. This has been shown with new imaging technics such as a Trabecular Bone Score (unfortunately not available in our area) that reveal the deficiency of the inside of the bones even when the DEXA scan (bone mineral density measure) is normal. For that reason, us practitioners and you patients have to be diligent about taking care of the bones. By that I mean: taking adequate levels of calcium supplementation (about 1000 to 1200 mg daily on average), vitamin d (for most patients 1000 to 5000 IU daily), discussing with your provider medical conditions (other than diabetes), medications, vices (smoking and excessive alcohol) that can worsen your bones and most importantly – exercise!!!!!!
In addition, if you, unfortunately, fall from standing height and fracture a wrist, shoulder, hip, pelvis or your spine (by the way, these latter ones sometimes present with back pain- though most are not even felt at all!) then you should be treated. Otherwise, there is a good chance (30% in 5 years) that you will sustain a second fracture!
I will leave the discussion about treatments for another blog, but just to mention, this year (3/2019) a new treatment for osteoporosis was approved by the FDA, Evenity, which helps build back bone. Remember, you and your providers should have a discussion about risks and benefits of each treatment – but keep in mind that ignoring the problem and choosing not to do much about it – is not a good idea!!!