Monday, October 10, 2011

Diabetes And Bones

I recently saw photographs of the actress Halle Berry on crutches. (See right for one.) Warner Bros. said she broke her foot "walking in Majorca on a day off from filming." Another source said she "stumbled over a rock and broke her foot."

It sounds odd to me that someone would break bones by walking, or stumbling over a rock. I know that Halle Berry has diabetes. And I know that people with long-standing diabetes (I believe she was diagnosed in her early 20s and is around 45 today) are at increased risk for fractures - type 1s because the low levels of insulin in early life lessen peak bone mass, type 2s for reasons not quite known ... poor vision, vascular complications, hormone imbalances. I suspect her diabetes contributed to her bone break.

Also, women at 45 are usually going through perimenopause or menopause, a time when estrogen and other hormones wane. These hormones help maintain bone.

An aside ... I thought Ms. Berry had type 1 diabetes until I read an interview where she claimed to have weaned herself from insulin injections by following a specific diet. Since type 1 involves loss of the insulin-producing beta cells, a condition not easily compensated by diet, it made me think she really had type 2, or perhaps MODY (Mature Onset Diabetes of the Young) where some insulin production persists. Although her diabetic coma at an early age does point to type 1.

Type 1's risk for osteoporosis is so high, and given her age, she may have been prescribed bisphosphonates. As I've written, these drugs can in fact increase risk for fractures.


Shreela said...

Not really related, but I can no longer comment on your other post that came through Google Reader. Delete this comment if you wish, since it's off-topic ^_^
(aka bone infarcts or osteonecrosis).

Even though diabetes isn't listed in the causes, my cousin was dx'd as Type 1 as a kid, and has had a couple of bouts with bone infarcts after "over-doing it" once he passed 50. His dr said it sometimes happens with long-term diabetics, although I don't know if that implied both types of just type 1.

Although the wikipedia article didn't mention inflammation, I suspect it also contributes if the teensy blood vessels supplying the bones become so inflamed that they come close to swelling shut.

My cousin is the eldest of all of us, and lives "back home" so spent a lot of time nursing the older generation during their last days, while waiting for relatives living the in big city to travel back home. So he pushed himself too hard and then suffered the bone infarcts for a few weeks after.

Bix said...

I think you're right about his diabetes contributing. The small vessels supplying bone would lose effectiveness. Could be plaque, could be inflammation, or other mechanism. It would make you wonder what's going on in the bigger vessels.

Shreela said...

Thanks for redirecting my comment to the correct post ^_^

Check the The Diabetes–Osteoporosis Link subtitle in this article for a theory about why Type 1 diabetics might have lower bone density early in life:
What People With Diabetes Need to Know About Osteoporosis

Bix said...

Excellent link!

By the way, I see you used the "a href" html to post a link. Google (I think) won't automatically add the link if I accept anonymous comments, which I like to do. I think it's their way of getting people to sign in? I should test that...

Bix said...

Something else I wanted to say. Even if her bones are fine, an injury like this is difficult for someone with diabetes. The healing takes longer, drugs they will give her, like antibiotics, will raise her blood glucose, in fact, inflammation itself will raise her blood glucose, causing her to have to compensate with more insulin, and risking over-compensating resulting in a dangerous low. (Any inflammation, even gum disease, increases blood glucose.)

It's times like these that diabetic complications, as I've seen, can advance ... eye problems, kidney problems. It's a treacherous time for a diabetic. (I'm not a doc, I'm only gabbing.)