Atlantic Endocrinology New York City

Can Diabetes Lead to Bone Problems?

If you have diabetes mellitus—commonly known as diabetes—you will be aware of potential complications of diabetes that may affect different body organs, including the eyes, kidneys, and heart.

At Atlantic Endocrinology & Diabetes Center we know and understand that there is one more thing risk to consider—and that is your risk for bone diseases.

Compared to people without diabetes, people with type 1 and type 2 diabetes have a higher risk for fractures, especially of the hip.

How diabetes affects bone health

The mechanisms behind diabetic bone disease are not entirely clear. Whether bone fragility happens alongside diabetes or is itself a complication of diabetes is a point of debate.

Diabetes mellitus changes your bone metabolism, which is one of the significant long-term complications we see in diabetes.

Diabetes increases the risk of periodontitis or gum disease. This leads to what we call alveolar bone loss, weakening the bones.

One complication of diabetes is microangiopathy, which is a disease of the small blood vessels. Microangiopathy is a type of microvascular disease related to bone mineral density, bone structure, and bone turnover.

What indicators of bone problems should healthcare professionals look for?

People with diabetes have the same risk factors for fracture as all adults. These risk factors include low BMD, falls, older age, being female, prior fracture, low body mass index, reduced physical activity, use of glucocorticoids, smoking, and consuming too much alcohol.

In patients with diabetes, there are other risk factors to look for, like having the disease for 5 years or longer and high glucose levels. If patients have hypoglycemia, that’s also going to increase their risk for falls and fractures.

At Atlantic Endocrinology & Diabetes Center we also know that some diabetes complications are associated with higher fall and fracture risk. These complications include peripheral neuropathy, poor vision, muscle weakness, and kidney disease NIH external link. They are all targets for treatment.

Bone Diseases Linked to Diabetes

Bone diseases associated with diabetes include osteoporosis, osteopenia, Charcot foot, diabetic hand syndrome, diffuse idiopathic skeletal hyperostosis, frozen shoulder, and Dupuytren’s contracture.

Osteoporosis

One of the most common bone diseases is osteoporosis, characterized by low bone mass and structural deterioration of bone tissues. It can lead to bone instability and increased risk of fractures of the hips, wrists, knees, and spine.

Osteopenia

In osteopenia, bones are weaker than usual. However, bone mass and density are not low enough to cause bones to break easily. Osteopenia can be seen as a middle point between having strong, healthy bones and having osteoporosis.

Charcot Foot

Also known as Charcot neuropathic osteoarthropathy, Charcot foot is a complication of diabetes that causes deformities in the foot and ankle. Symptoms include swelling, redness, and visible deformity.

Diabetic Hand Syndrome

Diabetic hand syndrome, also known as diabetic cheiroarthropathy, is a complication of both type 1 and type 2 diabetes where finger movement is limited, and the hands become waxy and thick. Diabetic hand syndrome is more common in people with long-standing, uncontrolled diabetes.

Diffuse Idiopathic Skeletal Hyperostosis

Diffuse idiopathic skeletal hyperostosis (DISH), also called Forestier disease, is a type of arthritis that affects tendons and ligaments—mainly in the spine. DISH causes tissues to become calcified (hardened) and bone spurs to develop in areas of the spine that connect to bone.

Frozen Shoulder

Frozen shoulder, also known as adhesive capsulitis, results when ligaments around the shoulder become inflamed and stiff. Both inflammation and diabetes make routine healing harder, causing the shoulder joint to become so stiff that it can make the simplest activities­—like buttoning a shirt­—difficult.

Dupuytren’s Contracture

Dupuytren’s contracture, also called palmar fascia, is a hand condition that gradually causes the connective tissues under the skin of the hand to become thick and severely scarred. While the disease is not always painful, it does restrict movement in the fingers and may cause them to curl and bend towards the palm.

Takeaways

High blood sugar increases the fragility of joints and weakens muscles. Managing BSL and ensuring you get sufficient exercise will help reduce the risk of joint problems.

Complement your exercise with a healthy, nutritious diet, preferably plant-based. Of course, the best solution is to fully reverse your diabetes; and this is realistically achievable through a proper plan involving diet, exercise, stress management, and medical supervision.

Cushing’s Syndrome: Causes, Complications and Treatment

What is Cortisol

‍At Atlantic Endocrinology & Diabetes Center we feel that before discussing Cushing’s, we must first discuss cortisol.

Cortisol is a glucocorticoid (steroid) hormone which plays an important role in glucose and fat metabolism and reducing inflammation.

The hormone is also referred to as the “stress” or “flight-or-fight” hormone, as it, along with epinephrine (adrenaline) is released during “flight-or-fight” situations.

What is Cushing’s Syndrome?

Cushing’s Syndrome is a disorder in which the level of the hormone cortisol increases in the body.

High cortisol causes weight gain around the abdomen, chest, face, and neck.

 Cushing’s Syndrome is a rare condition affecting around 10-15 out of one million people every year.

It strikes adults between 20 and 50 years of age, but it can also occur in children. Cushing’s Syndrome is more prevalent in women than men, contributing to about 70 percent of all cases.

Causes of Cushing’s Syndrome

Cushing’s Syndrome is caused due to the following reasons:

Long-term use of corticosteroid medicines

People who take high doses of corticosteroid medicines for a long time may develop Cushing’s Syndrome.

 Corticosteroids are usually prescribed to treat rheumatoid arthritis, asthma and to prevent rejection after organ transplantation.

Excessive production of the hormone cortisol

Several medical conditions can trigger the adrenal gland to produce too much cortisol, including:

• Tumor in the adrenal gland.
• Tumor of the pituitary gland increases the secretion of adrenocorticotropic hormone (ACTH), causing the adrenal glands to release more cortisol.
• Tumors in the pancreas, lungs, or thyroid can increase the secretion of adrenocorticotropic hormone (ACTH).

Signs and Symptoms

• Weight gain and fatty tissue deposits, particularly around the midsection and upper back, in the face (moon face), and between the shoulders (buffalo hump)
• Pink or purple stretch marks (striae) on the skin of the abdomen, thighs, breasts and arms
• Thinning, fragile skin that bruises easily
• Slow healing of cuts, insect bites and infections
• Acne
• Severe fatigue
• Muscle weakness
• Depression, anxiety and irritability
• Loss of emotional control
• Cognitive difficulties
• New or worsened high blood pressure
• Headache
• Infections
• Skin darkening
• Bone loss, leading to fractures over time
• In children, impaired growth

 Signs and symptoms women with Cushing syndrome may experience

• Thicker or more visible body and facial hair (hirsutism)
• Irregular or absent menstrual periods

Signs and symptoms men with Cushing syndrome may experience

• Decreased sex drive
• Decreased fertility
• Erectile dysfunction

Cushing’s Syndrome treatment

Various treatment options are available for Cushing’s Syndrome, depending on the causes of high cortisol.

Tapering the doses of corticosteroids

If Cushing’s Syndrome is caused due to over-use of corticosteroids, your doctor at Atlantic Endocrinology & Diabetes Center will gradually reduce the dose of the medicine. The doctor will recommend the lowest possible dose of corticosteroids required to manage your disease.

Surgically removing a tumor

If Cushing’s Syndrome is caused due to a tumor in the adrenal glands, pituitary gland, lungs, or pancreas, your doctor will suggest surgery to remove a tumor. It will reduce the production of cortisol hormones in the body. But after the surgery, patients will require hormone replacement therapy to maintain the levels of cortisol.

Radiation therapy

The doctor recommends radiation therapy if a tumor can not be removed via surgery or if a patient is unfit for surgery. In radiation therapy, small doses of radiation are given for six weeks, or a high dose of radiation is given all at once to destroy the tumor cells.

Medications

The doctor may prescribe medications such as Mitotane, Metyrapone, and Ketoconazole to reduce the production of cortisol. These medicines are used when other treatment options such as surgery and radiation therapy do not work.

After complete treatment, most patients observe improvements in the symptoms of Cushing’s Syndrome and recover fully.

How do Hormonal and Chemical Changes Impact Teens

Teens. They can be a whirlwind of emotions, sudden growth spurts, and newfound independence. Ever wonder why this happens? It’s all thanks to a surge of hormonal and chemical changes that take place during puberty.

During the Deen Years Yormones Can Impact

These hormonal changes are like little chemical messengers, instructing your body on how to develop from a child to an adult. Typically starting between ages 8 and 14, this period can last until your mid-20s. It’s no surprise things can feel a bit out of control!

Here’s a breakdown of how these changes impact you:

• Physical Growth: Hormones accelerate growth spurts, leading to changes in height, weight, and body shape.
• Skin Changes: Get ready for breakouts! Hormonal fluctuations can cause acne to appear.
• Brain Development: Alongside your body, your brain is also undergoing construction. This can affect your decision-making skills and emotional regulation.

It’s Not Just Physical

Teenagers often experience intense mood swings, heightened self-awareness, and even feelings of anxiety or depression. While hormones can amplify these emotions, they aren’t the sole cause. Underlying mental health concerns might require additional support from a therapist or counselor.

Remember, You’re Not Alone

These changes are a universal experience for teenagers. While it might feel overwhelming at times, understanding what’s happening can be a big help. It’s like a rite of passage, preparing you for adulthood!

Feeling Down? Seek Support

If you’re experiencing persistent feelings of sadness, worthlessness, or thoughts of suicide, hormones likely aren’t the culprit. These signs might indicate a deeper issue that needs professional help. Don’t hesitate to talk to a parent, trusted adult, or therapist.

Understanding different types of bone cancer

At Atlantic Endocrinology & Diabetes Center we know that bone cancer is relatively rare, accounting for 1% of all cancer cases in the United States.

Quite often, bone cancer is the result of metastasis. This means that cancer from elsewhere has spread to the bone. These cancers show the original cancerous cells and not those associated with bone cancer. In these cases, the cancer is treated by following the original course of treatment for the initial tumor.

But there are also primary cancers of the bone. This means that the cancer starts in the bone. Primary bone cancer is not common. Only 2 of every 1000 cancers diagnosed in the US each year are primary bone cancer. Bones are composed of:

• Osteoid tissue (hard or compact)
• Cartilaginous tissue (tough, flexible)
• Fibrous tissue (threadlike)
• Bone marrow (soft, spongy tissue in the center of most bones)

The type of bone cancer depends on where in the bone it starts.

There are two main types of bone cancer. In adults, cancers that form in the organs and spread to the bones, or metastasize, are the most common and are called secondary bone cancers. Primary bone cancers, also called bone sarcomas, develop in the bones and often spread to other areas.

The primary forms of bone cancer from most common to least common include:

• Osteosarcomas are tumors of the bone and are the most common form of bone cancer. Osteosarcomas are usually diagnosed in young people, but they do occur in older adults. These tumors often form in the arms, legs, or pelvis.
• Ewing tumor (Ewing sarcoma) is the second most common bone cancer in young people and third most common overall. These bone tumors often form in the hip, ribs, shoulder blades, spine, and legs.
• Chondrosarcoma forms in cartilage cells. The risk for this type of cancer increases with age and is rare in patients under 20. Chondrosarcomas are graded by severity from one to three.
• High-grade undifferentiated pleomorphic sarcoma (UPS) is another rare form of cancer that is often found in the soft tissues but can also occur in the bones, especially the legs, arms, and abdomen. It can also occur in areas of the body where radiation was received. UPS is most common in middle-aged and elderly adults.
• Fibrosarcoma is also rare in bones, occurring mostly in the soft tissues. It usually forms in the legs, arms, and jaw and is most common among adults 50 and older.

• Chordoma is a rare bone tumor that most often forms at the bottom of the spine or the base of the skull. It’s commonly diagnosed in older adults.

Giant cell tumor is another primary bone tumor often occurring in young people between age 20 and 30. However, the tumor is noncancerous, or benign, and usually forms near the joints of long bones, such as the shins and thighs.

The secondary types of bone cancer

There are several types of secondary bone cancer. These cancers are slightly different from metastasized bone cancer because they don’t form in the bone cells. Instead, they form in the blood or immune cells found in bone marrow.

The secondary types of bone cancer include:

• Multiple myeloma forms in a type of immune cells called plasma cells that are in the bone marrow. This type of bone cancer may develop as a single tumor but is usually found in several bones.
• Leukemia forms in the blood cells of bone marrow. There are many different types of leukemia. It can happen to people of all ages but is the most common cancer among young people.
• Non-Hodgkin lymphoma develops in the white blood cells of areas in the body that have lymph tissue. Primary non-Hodgkin lymphoma of the bone is a very rare type of lymphoma that forms in the bones.

Bone Cancer Risk Factors

Research is increasing regarding what we know about bone cancer. Scientists are learning more about its causes. Following are common risk factors for the disease:

Genetic Disorders – A small number of bone tumors are believed to be the result of genetic mutations:

• The Li-Fraumeni Syndrome – A mutation of the p53 tumor suppressor gene makes people much more likely to develop several types of cancer, including breast cancer, brain cancer, osteosarcoma, and other types of sarcoma.
• Rothmund-Thomson Syndrome – Children with this syndrome are short, have skeletal problems, and rashes. They also are more likely to develop osteosarcoma.
• Multiple Exostoses Syndrome – Patients with this inherited condition that causes many bumps on a person’s bones can have an increased risk of chondrosarcoma.

Radiation – Exposure to large doses of radiation may increase the risk of developing bone cancer. Radioactive materials such as radium and strontium can also cause bone cancer because these minerals build up in bones.