I've been saying this for years: bone density is not enough to predict osteoporosis. You need to look at bone fragility as well. And doctors don't have any way to measure this. But now a study out of UCLA has found a marker to help you determine your risk for developing fragile bones: insulin resistance. This study helps explain why so many people with type-2 diabetes who have high bone density still have weak bones and an increased risk for fractures.
It looks like insulin resistance is bad news for bones, even if it hasn't yet gotten to the point of diabetes. Even among non-diabetic middle-aged people, every time their measurements of the Homeostasis Model of Assessment-Insulin Resistance (HOMA-IR) doubled, their bone strength markers showed a 9-14% decrease. The higher the levels of fasting insulin, the weaker their bones.
These findings are helping researchers explain why patients with type-2 diabetes are well known for having a high risk of fractures, even though they often have higher bone mineral density than that of non-diabetics. Of course, obesity and insulin resistance already come with a laundry list of medical concerns; this is just another to add to the list.
But these findings do help confirm that measuring bone mineral density may not be enough to determine bone quality. They also offer an alternative to help assess the overall picture. In order to determine that there did seem to be a connection between insulin resistance and bone quality, researchers looked at 634 middle-aged men and women who were non-diabetic. They calculated bone mineral density in the lumbar spine and left hip and femoral neck axis length and width.
Then they looked at the connection between insulin resistance and three composite measures of femoral neck strength relative to load: compression strength index, bending strength index, and impact strength index. All of these measurements consider the physical dimensions of the femoral neck, bone mineral density, and load on the bone. Once they adjusted for age, sex, race/ethnicity, menopause transition stage in women, study site, and body mass index, they still found that doubling HOMA-IR resulted in statistically significant reductions in all three bone strength indices.
But they found something else that was very interesting. They found that a doubling of HOMA-IR also was associated with an 11% increase in bone mineral density in the femoral neck. Clearly, looking only at bone mineral density can be a misleading measure of bone health. Bone fragility is important as well, so it's important not to let insulin resistance get the better of you.
In addition to getting your insulin resistance under control, you may want to consider two supplements: magnesium and Ultimate Bone Support. Magnesium makes bones more flexible and less likely to break. Take 500 mg a day and eat plenty of whole grains and beans. Ultimate Bone Support provides your body with strontium and other nutrients proven to support healthy bones. Take them at different times of the day, since magnesium competes with strontium. Even if doctors can't get a fully accurate picture of your bone strength, you won't need to worry because you'll have done all you can to keep yours healthy!
Your voice of reason in Women's Health,
Dr. Janet Zand
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Srikanthan P, et al "Insulin resistance and bone strength: finding from the Study of Midlife in the United States" ENDO 2013; Abstract FP24-6.