Bone Disease

DEFINITION

• Osteoporosis and low bone density/osteopenia are important bone diseases observed in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM), characterized by decreased bone mass and structural deterioration of bone tissue, leading to bone fragility and increased susceptibility to fracture.
• On bone density measurements via dual energy X-ray absorptiometry (DXA): a T-score greater than -1.0 standard deviations (SD) is considered normal bone density, a score between -1.0 to -2.5 SD is low bone density/osteopenia, and a score equal to or below -2.5 SD is osteoporosis; Z-scores are used for men < 50 years and pre menopausal women.
• A Z-score less than or equal to -2.0 in young individuals is defined as low bone density for age.
• Osteomalacia is softening of the bone resulting from impaired bone mineralization with calcium, vitamin D, and phosphorus.
• Charcot foot is a result of bone loss in the foot or ankle causing microfractures, ligament laxity and bony destruction, exacerbated by neuropathy and patient’s inability to perceive ongoing trauma.