We often ignore our blood sugar levels, only paying attention when we feel sluggish after a meal or during routine check-ups.
However, blood sugar impacts much more than common symptoms like fatigue, thirst, or blurred vision—it can also impact your bone health over time.
In fact, research reveals that chronic high blood sugar levels can weaken your bones, increasing the risk of fractures by up to 2 to 4 times, regardless of your age or lifestyle. (1)
So, how can blood sugar make your bones weak and more prone to fractures, and what can you do to keep them strong and healthy as you age?
How Erratic Blood Sugar Levels Can Lead to Bone Loss
Chronically elevated blood sugar levels affect more than just your energy and mood—they can also compromise your bone health, increasing the risk of brittle bones and fractures. But how exactly does this happen?
Formation of Advanced Glycation End Products (AGEs)
When blood sugar levels stay high over time, the body starts producing harmful compounds called advanced glycation end products, also known as AGEs. (2)
AGEs are formed through non-enzymatic reactions between reducing sugars and proteins, lipids, or nucleic acids.
This process is similar to the Maillard reaction—a well-known chemical reaction that gives browned foods their distinctive flavor and color. (3)
AGEs can interact with structural proteins in the body, particularly collagen and elastin.
As we know, collagen is important for maintaining the strength and resilience of bones, tendons, and skin. It also adds elasticity, helping bones and tissue withstand physical stress without breaking. (4)
However, when collagen interacts with AGEs, it can alter the structure of the collagen fibers, making bones more brittle and prone to fractures.
One reason is that AGEs promote cross-linking between collagen molecules. (5)
Normally, cross-linking in collagen helps maintain the strength and stability of connective tissue by forming covalent bonds. However, excessive cross-linking caused by AGEs can make collagen fibers stiffer and less flexible.
This increased rigidity reduces your bones' ability to absorb shock and stress, raising the risk of fractures from falls or other impacts.
Collagen also undergoes continuous remodeling throughout life, where old fibers are broken down and replaced with new ones. (6)
AGEs disrupt this natural process by impairing enzymes like matrix metalloproteinases (MMPs) and cathepsin K, which are essential for collagen breakdown.
AGE-modified collagen is also more resistant to enzymatic degradation. This means that damaged or aged collagen accumulates instead of being replaced by fresh, healthy fibers.
Over time, this buildup of altered collagen can weaken bone quality, increasing your risk of fractures.
Altered Bone Cell Function in Diabetes
Chronic high blood sugar levels can disrupt the natural balance between osteoblasts (cells that build new bone) and osteoclasts (cells that break down old bone tissue). (7)
Under normal conditions, these cells work together to maintain bone density and strength. However, if you have chronic hyperglycemia, this balance is often disrupted, leading to increased osteoclast activity and resulting in more bone breakdown than bone formation.
One of the reasons for this is chronic inflammation due to persistent high blood sugar levels. (8)
Inflammatory cytokines like tumor necrosis factor-alpha (TNF-α) and interleukin-6 (IL-6) can stimulate the production of RANKL (receptor activator of nuclear factor kappa-Β ligand), which promotes the formation of osteoclasts and enhances bone resorption.
When osteoclast activity outpaces osteoblast function, bone density decreases, making bones more fragile.
Moreover, chronic high blood sugar can interfere with bone mineralization—the process of incorporating calcium and phosphate into the bone matrix—compromising bone strength. (9)
This can result in bones that are denser but less resilient, making them more vulnerable to fractures.
Elevated blood sugar also triggers oxidative stress, increasing the apoptosis (programmed cell death) of osteoblasts and their precursor cells. (10)
This, combined with insulin deficiency and low levels of insulin-like growth factor 1 (IGF-1), further impairs osteoblast function, reducing bone formation and increasing fragility over time. (11)
For instance, diabetic patients may have normal or even elevated bone mineral density (BMD), but they can still face a higher risk of fractures due to poor bone quality caused by these cellular changes. (12)
A study published in Diabetes Care examined this issue by analyzing data from 4,135 participants in the Rotterdam Study over a 12.2-year follow-up period.
Participants were categorized into three groups: those with adequately controlled diabetes (ACD), inadequately controlled diabetes (ICD), and non-diabetics. Interestingly, the ICD group showed slightly 1.1-5.6% higher BMD and thicker cortical bones but had narrower femoral necks compared to the other groups.
Despite their higher BMD, those with poorly controlled diabetes had a 47-62% greater risk of fractures compared to those without diabetes or with well-controlled diabetes, whose fracture risk was similar.
This suggests that poor glucose control may increase bone fragility, likely due to microcrack accumulation and impaired bone repair, even in bones that appear structurally strong.
Similarly, those with insulin deficiency are at a 6- to 7-fold higher risk of hip fractures compared to the general population, while those with insulin resistance have a 1.4- to 1.7-fold increased risk. (13)
As a result, these people are at a compounded risk of skeletal problems, including bone loss and delayed fracture healing.
Impaired Fracture Healing
People with chronic blood sugar levels also recover from bone fractures more slowly than expected. This delayed healing is largely due to diabetes-related metabolic disruptions that hinder the body’s natural bone repair process. (14)
Bone healing begins with mesenchymal stem cells or adult stem cells capable of differentiating into various types of cells, which differentiate osteoblasts—the cells responsible for creating new bone. (15)
However, if your blood sugar levels are consistently high, these stem cells don’t respond as efficiently, slowing down the healing process.
In fact, fractures in patients with blood sugar issues may take up to 87% longer to heal than in those without, increasing their risk of complications such as delayed union (slowed healing) or nonunion (when the bone fails to heal completely). (16)
A study published in Current Osteoporosis Reports also revealed that patients with diabetes are approximately 3.4 times more likely to experience wound complications after surgery. (17)
Researchers examined a cohort of 179 patients with 190 calcaneus fractures, all treated with open reduction and internal fixation (a surgical procedure using plates and screws to stabilize the bone).
The results showed that 25% of participants experienced wound complications, while 21% required additional surgery.
The researchers identified three key risk factors for these complications: smoking, open fractures, and diabetes.
Notably, patients with diabetes are at a significantly higher risk of wound complications compared to those without the condition.
Elevated blood sugar levels can also impair healing by disrupting normal cell functions and reducing the production of essential growth factors, such as transforming growth factor-β (TGFβ) and insulin-like growth factors (IGFs), both crucial for bone repair. (18)
IGF-1 is important in cell proliferation and wound re-epithelialization, while TGFβ helps recruit immune cells, fibroblasts, keratinocytes, and vascular cells, supporting angiogenesis and extracellular matrix (ECM) formation. (19)(20)
These growth factors are important in stimulating cell growth and promoting healing at the fracture site.
Without sufficient levels, the body struggles to restore damaged bone effectively.
Changes in Bone Microarchitecture
Bone microarchitecture is the inner framework that gives bones their strength and resilience. It includes the arrangement of spongy trabecular bone and the thickness of the denser, outer cortical bone. (21)
However, chronic high blood sugar problems can weaken this internal structure, putting you at higher risk of fractures. (22)
For instance, persistently high blood sugar levels can disrupt the connectivity of trabecular struts—tiny supports within the bone that help maintain its strength and flexibility. (23)
It can also thin out the cortical layer and increase bone porosity, making bones more fragile from the inside out. (24)
This means that even if your bone density appears normal (or slightly higher), the actual quality and strength of the bone could be compromised, making it less capable of handling stress.
In fact, a study in the Journal of Clinical Endocrinology & Metabolism found variations in bone mineral density, with hip Z-scores averaging approximately -0.37 ± 0.16, depending on whether someone was insulin deficient or resistant. (25)
People with insulin resistance also face a higher risk of fractures, not because their bones are necessarily less dense but because the internal quality and integrity are compromised.
In other words, blood sugar issues don't just impact bone density—they alter the very architecture that gives your bones strength, increasing your fracture risk even when standard bone density scans look fine.
Increased Risk of Falls
People with chronic high blood sugar are also at a higher risk of falls, often leading to serious injuries like fractures.
This increased risk is due to complications such as nerve damage, vision impairment, and muscle weakness, all of which can affect balance and coordination, making falls more likely.
Nerve damage often causes symptoms like tingling, numbness, and pain in the feet and legs, disrupting the body's ability to sense the feet on the ground.
This loss of sensory feedback makes it harder to maintain balance, increasing the likelihood of falls.
In fact, older adults with blood sugar issues are 63% more likely to experience falls than those without due to these sensory challenges. (26)
This was confirmed by a study published in the Journal of BMC Geriatrics, which analyzed data from 12 studies, including 8 in a meta-analysis, involving 40,778 participants aged 60 to 101 years.
The study found that older adults with insulin resistance are 63% more likely to fall than those without, with the overall risk of falling being approximately 59% higher for this group.
Blood sugar imbalances can also affect vision and depth perception, making it difficult to navigate safely. Poor vision can lead to misjudging distances or missing obstacles, creating trip hazards and increasing the risk of falls and fractures. (27)
Additionally, persistent high blood sugar can weaken muscles, making it harder to maintain stability when walking or standing, further elevating the fall risk. (28)
Interestingly, while insulin therapy can help manage blood sugar levels, it can also increase the risk of falls.
Low blood sugar episodes can lead to dizziness, confusion, and muscle weakness—factors that contribute to instability.
As a result, people using insulin are notably more likely to fall compared to those who don’t use it, with some studies indicating an increased risk of up to 162%, depending on their health status and other factors. (29)
Calcium Loss Due to Kidney Problems
Chronic high blood sugar levels can lead to kidney issues that deplete calcium, which is essential for strong bones. This disrupts normal mineral metabolism, affecting both kidney function and bone quality. (30)
The disorder triggers a series of biochemical changes, including increased parathyroid hormone (PTH) levels, decreased production of active vitamin D (1,25-dihydroxyvitamin D), and imbalances in serum calcium and phosphate levels. (31)
As kidney function declines, calcium absorption from the diet decreases, while urinary calcium loss increases, resulting in a calcium deficit. (32)
In cases of advanced kidney disease, elevated serum calcium may lead to kidney calcification, impairing filtration, promoting inflammation, and accelerating kidney damage.
Additionally, secondary hyperparathyroidism, common in those with kidney issues linked to chronic high blood sugar, raises PTH levels, which breaks down bone faster and reduces bone density, increasing fracture risk. (33)
Elevated blood sugar levels can also interfere with renal tubular cell function, which is crucial for calcium reabsorption. This excessive calcium loss further reduces bone density and heightens the risk of fractures. (34)
Bone Loss Due to Certain Blood Sugar Medications
Certain oral blood sugar medications, particularly thiazolidinediones (TZDs) like pioglitazone and rosiglitazone, can contribute to bone loss and increased fracture risk.
These medications activate peroxisome proliferator-activated receptor-gamma (PPAR-γ), which is involved in glucose and fatty acid metabolism but also affects bone remodeling. (35)
When activated by TZDs, PPAR-γ disrupts the balance between bone resorption and formation, promoting bone breakdown while inhibiting new bone formation. This leads to a net loss of bone density over time, making bones more prone to fractures.
Research shows that TZDs can impair osteoblast development (the cells responsible for bone formation) while stimulating osteoclasts (the cells that break down bone tissue), accelerating bone loss. (36)
This is especially concerning for postmenopausal women, who already experience declines in bone mineral density (BMD).
For example, older postmenopausal women using TZDs have been found to lose about 0.5% to 1% of their BMD annually, compared to those not using these drugs. They are also at an estimated 2-3 times higher risk of fractures, particularly nonvertebral fractures like those of the hip, wrist, and upper arm. (37)
In fact, a study called the Diabetes Outcome Progression Trial (ADOPT) found that patients taking the drug rosiglitazone had a higher risk of fractures compared to those taking metformin or glyburide.
The study followed 4,351 participants (1,840 women and 2,511 men) for about four years.
In the study, 9.3% of women on rosiglitazone had at least one fracture, compared to 5.1% of women on metformin and 3.5% on glyburide.
Over five years, the fracture rate was 15.1% for those on rosiglitazone, 7.3% for those on metformin, and 7.7% for those on glyburide.
Women taking rosiglitazone had a fracture risk 1.81 times higher than those on metformin and 2.13 times higher than those on glyburide.
Fractures mostly occurred in the arms and legs and affected both pre- and postmenopausal women.
This risk is further heightened by age, gender (with women at greater risk), and longer duration of TZD use.
How to Protect Your Bones From Blood Sugar Fluctuations
If you’re concerned that fluctuating blood sugar might be harming your bones, it’s important to practice a healthy lifestyle that supports both bone strength and stable blood sugar levels.
Maintain a Healthy Body Weight
Keeping a healthy weight does more than just help you look and feel good—it’s also crucial for your blood sugar and bone health. When you maintain a balanced weight, your body can use insulin more effectively, helping stabilize blood sugar levels. (38)
Additionally, it lowers your risk of complications like nerve damage, vision problems, and muscle weakness—all factors that can increase your chances of falling.
On the other hand, carrying extra weight puts added stress on your bones and joints, while being underweight can weaken bone density.
The good news? A balanced diet and regular weight-bearing exercise support healthy bone remodeling. This process helps your bones stay strong by balancing new bone formation with bone breakdown, reducing the risk of fractures and brittle bones. (39)
And don't forget—reach out to the Bone Coach team for expert advice on weight-bearing and strength training that can boost bone strength and reduce fracture risks. (40)
Avoid Smoking and Limit Alcohol Intake
Smoking harms your bone health by reducing blood flow, which limits the activity of osteoblasts—the cells that build new bone. It also interferes with calcium absorption, leading to weaker bones and a higher risk of bone loss. (41)
Nicotine doesn’t just harm your lungs; it also affects your insulin sensitivity, making it harder for your body to regulate blood sugar. This can contribute to disruptions in bone metabolism and speed up bone loss. (42)
Similarly, heavy alcohol use is a double threat—it impacts both blood sugar and bone health, causing significant fluctuations in blood sugar levels and increasing the risk of insulin resistance. This makes it harder for your body to absorb key nutrients like calcium and vitamin D, which are essential for bone strength. (43)
Over time, excessive drinking disrupts bone remodeling, the natural process of replacing old bone with new. This can lead to lower bone density, making your bones brittle and more prone to fractures. (44)
While light to moderate drinking may have little impact, heavy alcohol use significantly raises your risk of weakened bones, especially if your blood sugar levels are already compromised.
For stronger bones and better blood sugar control, it’s important to quit smoking and reduce alcohol intake. These lifestyle changes help stabilize blood sugar levels and support bone health, significantly lowering your risk of bone loss and fractures.
Eat Foods Rich in Calcium and Vitamin D
Eating foods rich in calcium and vitamin D can support healthy bone health and may help with blood sugar management.
Calcium is important in bone formation and density, while vitamin D enhances calcium absorption in the body. Together, they help strengthen bones and reduce the risk of bone loss. (45)
Moreover, adequate calcium and vitamin D intake can potentially support insulin sensitivity, which helps regulate blood sugar levels. (46)
By incorporating calcium and vitamin D-rich foods—such as salmon, sardines, mackerel, cultured and fermented dairy like kefir and yogurt, organic tofu, white beans/cannellini beans, chia seeds, and cabbage—into your diet, you can promote strong bones as well as better overall health.
Supplement With Vitamin E Tocotrienols
In addition to the usual bone health essentials like calcium, vitamin D, and collagen, consider adding vitamin E—specifically, the tocotrienol form—to your supplement routine for additional bone support.
Tocotrienols, a potent type of vitamin E, play a crucial role in supporting bone health in several key ways:
- They promote the proliferation and differentiation of osteoblasts, the cells responsible for bone formation, while simultaneously inhibiting the formation and activity of osteoclasts, which break down bone tissue. This dual action helps maintain a healthy balance between bone formation and resorption, which is important for preventing osteoporosis. (47)(48)
- Tocotrienols also possess strong antioxidant properties that reduce oxidative stress and inflammation—two factors detrimental to bone health—by downregulating pro-inflammatory cytokines and enhancing antioxidant enzyme expression. (49)
- Tocotrienol supplementation can also support bone microarchitecture, including increased trabecular connectivity and overall bone strength, making your bones more resilient. (50)
This has been shown in a study published in BMC Complementary and Alternative Medicine, where 87 postmenopausal women who received DeltaGold® annatto tocotrienol at dosages of 300 and 600 mg for 12 weeks experienced decreased bone resorption and improvements in bone formation. (51)
They also showed a significant increase in the BALP/NTX ratio, a measure of bone remodeling, along with a reduction of approximately 13-24% in the RANKL/OPG ratio, indicating decreased bone resorption compared to increases in the placebo group.
Moreover, tocotrienols can activate PPAR alpha, which helps control the genes that are involved with burning fatty acids for fuel. (52)
PPAR alpha, also known as peroxisome proliferator-activated receptor alpha, is important in regulating lipid metabolism in the liver.
Activation of PPAR alpha can support blood glucose and insulin sensitivity and control elevated blood triglycerides, which is one of the hallmarks of metabolic syndrome. (53)(54)
Specifically, gamma- and delta-tocotrienols are effective for lowering triglycerides by restraining genes that start triglyceride production.
In fact, a study published in the Journal of Atherosclerosis and Thrombosis found that two months of supplementation with gamma- and delta-tocotrienols supported a reduction in triglyceride levels by about 28% in the blood of human subjects and approximately 10% in patients with metabolic syndrome. (55)
Therefore, by maintaining healthy blood sugar levels, you also promote strong, healthy bones, setting the foundation for an active future.
The good news?
Annatrol™ Bone Support by Healthy Bones Co. contains DeltaGold® tocotrienol derived from annatto, which is recognized as the only known plant source of tocotrienols with virtually no tocopherols.
Therefore, by taking Annatrol™ Bone Support, you address two essential health priorities at once: supporting bone health and maintaining balanced blood sugar levels.
This dual action not only helps maintain healthy bone structure and integrity but also enhances overall metabolic function, reducing your risk of complications related to imbalanced blood sugar.
Not only that, but Annatrol™ Bone Support also contains 300 mg of geranylgeraniol (GG), a compound important for synthesizing vitamin K2 (MK-4), which plays a crucial role in effective calcium transport to the bones.
MK-4 is essential for bone repair and maintenance, as it activates proteins, such as osteocalcin and matrix Gla-protein, that regulate calcium utilization in the body.
This not only helps build stronger bones but also prevents the accumulation of calcium in soft tissue, such as the arteries, supporting both bone and cardiovascular health.
By replenishing GG levels, you can help combat age-related physical decline, support structural integrity, and reduce skeletal muscle fatigue.
Therefore, if you're looking to support both bone health and stable blood sugar levels for an active and healthy future, give Annatrol™ Bone Support a try!
Moreover, just two pea-sized capsules of Annatrol™ Bone Support offer other health benefits beyond supporting bone health.
- Helps maintain skin and eye health*
- Promotes cardiovascular and circulatory health*
- Promotes regulation of healthy metabolic functions*
- Supports insulin sensitivity and normal glycemic control*
- Promotes a healthy inflammatory response*
- Supports antioxidant status*
- Maintains healthy liver function*
- Helps mitochondrial function and cellular energy generation*
- Supports hormone synthesis*
- Supports proper cell membrane construction*
- Provides support for a healthy lipid profile and total cholesterol levels*
Support healthy and strong bones before, during, and after menopause.
Try Annatrol™ Bone Support today.
