Prediabetes | Poor Bone Health With Hard Bones?

Maintaining healthy blood sugar levels and body weight to ward off prediabetes can benefit you right down to the inside of your bones.

human skeleton showing bonesAs a podiatrist – foot surgeon, one of the factors I take into account during the evaluation of someone who may need foot surgery is the strength and quality of their bones. I can get some idea of this from their medical history, looking at a foot x-ray, and of course, this can be appreciated in surgery as I am working with the bones of the foot.

A recent study looked at the association of how much body fat people had around their mid-section and their bone health. Specifically, forty pre-menopausal women with an average Body Mass Index (BMI) of about 30.

The researchers observed lower bone quality in overweight women with excess fat at their mid-section. These women had weaker bones than their lighter peers who didn’t have as much mid-section body fat.

What is also interesting is that all the women had normal bone mineral density studies suggesting that doctors may not be able to fully rely on these studies to get an accurate gauge of bone quality – having hard bones that appear hard enough with bone density testing, does not necessarily mean you have healthy, good quality bones.

The women with the most mid-section fat had more porous bones with lower bone quality overall. Healthy bones are strong because of a good internal support structure. It was found that the women with excess “stomach body fat” had a weaker internal bone support structure.

Compared to women with the lowest amount of mid-section fat, the women with the highest amount of mid-section fat had less bone quality with:

• less internal support structure

• less stiffness

• more porous bones

In addition, the bone formation rate was 64% lower among the heavier women with mid-section fat.

Some studies have suggested that increased body weight may potentially protect someone from weak bones, known as osteopenia or osteoporosis, because the increased stress on the bones from carrying around extra body weight helps maintain bone strength, and therefore presumably quality. These studies have generally been done using the bone density test I mentioned above.

The study I cite here actually looked inside the bones of the participants using bone biopsies to evaluate their bone health. This raises the question as to whether being overweight may harden bones, but leaves people with poorer quality bones overall. Or perhaps it is where the excess body weight is carried that may provide some benefit to bone strength and quality? In other words, we know that having extra fat in the hips and thighs is not as harmful as carrying it in the front of the abdomen. Perhaps women with more weight in their hips and thighs maintain some positive influence on bone health?  In addition, I suspect that the amount of muscle mass in the people with a higher BMI is a factor in this finding that needs to be investigated. Increased muscle mass can “falsely elevate” BMI.

woman with excess abdominal visceral fatIt may be interesting to look at the older bone studies that suggest a higher BMI may be helpful against osteoporosis and see if there was any difference in where the beneficiaries carried their extra weight – abdomen versus hips and thighs. It would also be helpful to know their body composition, not simply their BMI.

As many readers know, men and women who carry excess fat in their abdominal mid-section area, so-called visceral fat, have one of the criteria for metabolic syndrome and prediabetes. It has been established that this fat produces inflammation throughout the body and helps set the stage for the insulin resistance that is another part of prediabetes-metabolic syndrome, bringing one even closer to full diabetes with all its potentially life-changing complications.

If you are going to put on weight, it’s better in the legs. This is especially important for muscle as well. Maintaining muscle in the legs becomes most important as we age and mobility becomes compromised.

The authors conclude:

At the tissue level, premenopausal women with more central adiposity had inferior bone quality and stiffness, and markedly lower bone formation. Excess mid-section fat has an effect on the entire body. This fat accumulation puts out hormones and other biological compounds that instigate inflammation and disrupt your metabolism.”


How can bone health be supported in people with prediabetes-metabolic syndrome?

people eating a healthy prediabetes dietPrediabetes-metabolic syndrome can at the very least be improved, if not outright stopped with lifestyle change. The decision is yours to make. Learn about what you need to do to improve your metabolism and reverse prediabetes. A proper diet encouraging loss of mid-section fat is the first step. Learn what it means to eat a proper diet to help you reduce the insulin resistance that is part of metabolic syndrome. Food is medicine.

As a matter of fact, consistent with the study mentioned above, insulin resistance itself has been associated with decreased bone strength without decreased bone mineral density.

A meta-analysis has also shown an association between metabolic syndrome and bone health in men suggesting that metabolic syndrome is a risk factor for developing osteoporosis in men.

These studies are “association studies” and because of this, it doesn’t mean that excess mid-section fat, or insulin resistance, causes diminished bone health. It just says that finding these two conditions together is not simply a coincidence, and there appears to be some relationship between them.


Nutrients, diet supplements and exercise as medicine for bone health

Calcium and vitamin D are often used to support bone health in an effort to improve osteopenia or osteoporosis, especially in post-menopausal women. Some studies have shown that calcium itself can impact bone density in post-menopausal women. Most of the literature supports calcium and vitamin D together to support bone health. These two nutrients work together along with many others.  In addition, most of the recent medical literature cautions against taking too much supplemental calcium as it may have negative consequences on the cardiovascular system (your heart and blood vessels).

Adequate vitamin D levels are also important. This is true not only for bone health, but a healthy vitamin D level is important for a healthy metabolism to help you stop prediabetes, and prevent full type 2 diabetes with all its nasty complications. If you have been told by your doctor that you have some “thinning of your bones,” it is usually a good idea to not only check your bone density, but your vitamin D level as well. A recent study showed that low vitamin d levels increase one’s risk of a broken bone.

And last, but not least, movement.  Particularly some form of weightbearing movement if you are able. If you are not, then consider non-weightbearing exercise movements, either endurance aerobic type exercise-movement on a recumbent bike, for example, or non-weightbearing resistance exercises.

pre diabetes exercise resistance training in a poolExercising in a pool and taking some stress off of your body is a good way to start if you are overweight or obese, and need some assistance with reducing stress on joints, and for balance. As with all exercise approaches, start slowly and gradually increase your intensity for better exercise-effects on your metabolism. Once your heart, lungs, brain and muscles are all working well together, it’s only a matter of time before your mid-section fat melts away, your bones get healthier and you no longer have prediabetes. It’s a better feeling looking toward getting older while being able to continue to live functionally and independently without the threat of diabetes complications.

 Go to the Nutrientology Store to get Vitamin D3 or see all Joint Support.

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About Robert Creighton

Dr. Creighton is a podiatrist and foot surgeon with over 26 years in podiatric practice treating thousands of patients afflicted with the physiological, physical, and psychological side effects and complications of diabetes and pre-diabetes metabolic syndrome. He believes these disorders present a pressing public health concern that need to be more actively addressed in a multidisciplinary way. Dr. Creighton graduated from what is now the Temple University School of Podiatric Medicine after receiving his undergraduate degree in Biology. He is certified by the American Board of Foot and Ankle Surgery, a member of the American Public Health Association, an American College of Sports Medicine certified personal trainer and a Member of the American Nutrition Association.

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