Supplementation with vitamins C and D lowers the risk of bone fractures in diabetes

Vitamin D’s role in bone health is well established, but according to a study that is published in Human Nutrition & Metabolism, a combination of vitamins D and C has a better effect against week bones and bone fractures in patients with diabetes. The study authors address vitamin C’s role in bone health but also mention the importance of having enough magnesium, which is needed to regulate the body’s calcium distribution.

Bone mineral density (BMD) that is a measure of bone health is often reduced in connection with diabetes and other chronic illnesses. Lowered bone density increases the risk of bone fractures, hospitalization, and other complications. Vitamin D is known for its supportive role in the body’s uptake of calcium and phosphorous and for its importance for bones, which contain these minerals. Also, vitamin C plays a key function in the production of collagen, which is the main ingredient in connective tissue. Vitamin C also inhibits the activity of a class of cells called osteoclasts that break down old bone tissue. Osteoblasts, on the other hand, are bone-building cells that make new bone tissue, which primarily consists of collagen and calcium. It is therefore important to have the right balance between these two kinds of cells. If the osteoclasts suddenly become more active than the osteoblasts, we lose bone tissue and may eventually develop osteoporosis.
Science has also discovered that a molecule named VCAM-1 enhances the activity of osteoclasts, thereby speeding up the loss of bone mass.
Many people don’t get enough dietary vitamin C from fruits and vegetables, and it is also known that diabetics often have lower levels of vitamin D in their blood.
The study therefore aimed at finding out if the body’s vitamin C and D status was linked to bone mineral density and VCAM-1 in female diabetics.
The researchers did not find a relation between blood levels of vitamin D, bone mineral density, and VCAM-1. However, they did find a significant and positive relation between vitamin C and bone mineral density, and a negative relation between vitamin C and VCAM-1.

Why are diabetics more likely to develop osteoporosis?

Diabetes is a metabolic disease characterized by oxidative stress and chronic inflammation with an overrepresentation of free radicals, which are aggressive molecules that attack and damage cells and tissues. Long-term chronic inflammation and oxidative stress can also result in damage to the bone-forming cells (osteoblasts) and cause bones to demineralize. Vitamin C is a powerful antioxidant and free radical scavenger that can protect against the harmful effect of oxidative stress. According to the researchers behind the study, it is better to take a combination of vitamins C and D rather than taking D alone. Also, one should consider supplementing with magnesium.

The interplay between vitamin D and magnesium is also important for bones

Diabetics often have lower vitamin D levels in their blood than others. Still, the scientists did not find any link between blood levels of vitamin D and bone density, which may be because of metabolic disturbances related to diabetes. Diabetics may have difficulty with converting vitamin D into its active steroid form (calcitriol) in their kidneys and in other tissues. Calcitriol regulates a host of different genes and metabolic processes. Magnesium-containing enzymes are also important for vitamin D synthesis and the conversion of 25(OH)D into calcitriol. The body is unable to convert and utilize vitamin D properly in the case of a magnesium deficiency. Magnesium is also important for controlling the process where calcium is embedded into bone tissue for and for maintaining a low calcium concentration in all cells in soft tissues. According to another article that is published in Frontiers in Nutrition, magnesium deficiencies are rather common among diabetics, which can affect their blood sugar levels as well as their bone health and different metabolic processes.

• Vitamin C supports bone through its role in collagen synthesis, by inhibiting bone-destroying osteoclasts, and by serving as an antioxidant that protects against oxidative stress.
• Vitamin D supports bones by regulating the body’s uptake of calcium and phosphorous
• Magnesium supports bones by activating vitamin D and by embedding calcium into bone cells

References:

Erin Hunter. Supplementation of Vitamin C, Vitamin D May Reduce Risk of Fracture in Patients With Diabetes. Pharmacy Times. 2024

Stevens CM et al. The association of vitamin C and vitamin D status on bone mineral density and VCAM-1 levels in female diabetic subjects: Is combines supplementation with vitamin C and vitamin D potentially more successful in improving bone health than supplementation with vitamin D alone? Human Nutrition & Metabolism. 2023

Ya Liu et al. Dietary magnesium Intake Level Modifies the Association Between Vitamin D and Insulin resistance: A Large Cross-Sectional Analysis of American Adults. Frontiers in Nutrition 2022