Are there any illnesses or medical conditions that are associated with osteoporosis

If you have certain illnesses, you are definitely more at risk for developing osteoporosis either because of the illness itself or the medications used to treat the underlying illness interfere with bone development (see Question 16).

Some illnesses, such as hyperthyroidism and Cushing's syndrome, increase the speed with which bone is broken down. Other illnesses, such as cystic fibrosis and celiac disease, interfere with bone formation by impeding the body's absorption or production of the nutrients needed for bone development. In fact, 3% to 4% of those with osteoporosis have gluten intolerance, the allergy to wheat that occurs in celiac disease. People with gluten intolerance cannot absorb the correct amount of calcium and Vitamin D from their intestines. One of the problems is that many people have minor symptoms and do not even know they have an allergy to wheat. Gluten intolerance can also occur later in life.

Table 1 lists illnesses and medical conditions that can interfere with good bone health. Most of the illnesses listed are chronic; however, other illnesses or conditions can be shorter term, meaning that the bone loss

Table 1 Medical Conditions that Cause or Increase Risk for Secondary Osteoporosis

Adrenal

Acromegaly Insufficiency Alcoholism Amyloidosis

Androgen Insensitivity

Ankylosing Spondolytis

Anorexia Nervosa

Athletic Amenorrhea

Breastfeeding

Calcium Deficiency

Celiac Disease

Cholestatic Liver Disease

Chronic Liver

Disease

Chronic Obstructive Pulmonary Disease

Chronic Metabolic Acidosis

Congestive Heart Failure

Cushing's Syndrome

Cystic Fibrosis

Depression

Diabetes Mellitus, Type 1

Ehlers-Danlos Syndrome

Emphysema

End Stage Renal Disease

Epilepsy

Gastric Disease Operations (Gastrectomy/ Bypass)

Gaucher's Disease

Glycogen Storage Diseases

Hemochromatosis

Hemophelia

Homocystinuria

Hyperadrenocorticism

Hypercalciuria

Hyperpara-thyroidism

Hyperprolactinemia

Hypogonadism

Hypophosphatasia in Adults

Idiopathic Hypercalciuria

Idiopathic Scoliosis

Immobilization

Inflammatory Bowel Disease

Klinefelter's Syndrome

Leukemias

Lupus

Mastocytosis

Malabsorption Syndromes

Malnutrition

Marfan Syndrome

Menkes Kinky Hair Syndrome

Table 1 Medical Conditions that Cause or Increase Risk for Secondary Osteoporosis (cont.)

Multiple Sclerosis

Muscular Dystrophy

Myeloma and Some

Cancers Organ Transplantation

Table 1 Medical Conditions that Cause or Increase Risk for Secondary Osteoporosis (cont.)

Multiple Sclerosis

Muscular Dystrophy

Myeloma and Some

Cancers Organ Transplantation

Osteogenesis Imperfecta

Panhypopituitarism

Porphyria

Posttransplant Bone Disease

Pregnancy

Premature Ovarian Failure

Primary Biliary Cirrhosis

Renal Tubular Acidosis

Rheumatoid Arthritis

Riley-Day Syndrome

Sarcoidosis

Sickle Cell Disease

Thalassemia

Thyrotoxicosis

Turner's Syndrome

Vitamin D Deficiency

Sources: U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General; 2004. and

American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Prevention and Treatment of Postmenopausal Osteoporosis: 2001 edition, with Selected Updates for 2003. Endocrine Practice 2003;9:544-564.

Sources: U.S. Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General; 2004. and

American Association of Clinical Endocrinologists Medical Guidelines for Clinical Practice for the Prevention and Treatment of Postmenopausal Osteoporosis: 2001 edition, with Selected Updates for 2003. Endocrine Practice 2003;9:544-564.

caused by the illness or condition can be reversible. For example, pregnancy and lactation cause temporary bone loss because calcium is needed by the developing fetus and the infant who is breastfeeding. But pregnancy- and lactation-associated bone loss stops either after delivery of the baby or the weaning of the baby from the breast. Interestingly, this transient bone loss does not have long-term effects and is not changed by taking additional calcium during pregnancy or lactation. Hypogonadism, or low testosterone levels, is a chronic condition that affects men and can interfere with normal bone development.

Individuals with chronic kidney disease usually have high levels of phosphorus in the blood. High blood levels of phosphorus put them at increased risk for osteoporosis. They must take a special medication

Hypogonadism

Inadequate testicular or ovarian function most commonly causing low levels of testosterone.

Dialysis

Process by which impurities and toxic substances are removed from the body either by filtering blood through a machine or infusing fluids into the abdominal cavity that remove wastes; required for those who do not have adequately functioning kidneys.

called Renagel (sevelamer) that binds the extra phosphorus and allows the body to excrete the surplus through the intestines. Those who are on dialysis often have their blood checked weekly for phosphorus levels and their Renagel™ dosage adjusted accordingly.

Because depression is definitely a medical condition associated with low bone mass and decreased BMD, some clinicians recommend screening for osteoporosis in older individuals with major depression who may not have other risk factors. Depression is also associated with an increased risk for falls. It is not entirely clear whether the diagnosis and effects of having osteoporosis cause the depression or if the chemical imbalance or sedentary lifestyle resulting from depression interferes with bone development.

There are several reasons why asthma also can be a serious risk factor for developing osteoporosis. First, steroid medications are often used to decrease inflammation of the airway. These medications are known to increase bone loss (see Question 16). Second, many asthma sufferers are convinced that milk and milk products increase mucus production, and therefore they avoid a group of foods that contain calcium. They may also avoid milk because they believe it will trigger an asthma attack, but unless you are allergic to milk, there is no evidence that this will occur. And last, exercise can be a trigger for an asthmatic attack. Those who suffer from exercise-induced asthma may become sedentary, avoiding the weight-bearing or resistive exercises required for bone growth.

Marianne's comment:

I have been on hemodialysis for kidney disease for well over a year. I have to be very careful about eating foods that are too high in phosphorus because my kidneys are not able to process the phosphorus correctly. My nephrologist does not want my phosphorus levels to get too high because calcium will be taken from my bones, making them weaker. Also, the phosphorus makes my skin itch. Although I take Renagel to keep the phosphorus levels down, the dialysis also removes phosphorus from my blood. Food labels dont contain phosphorus levels, so it's sometimes difficult to know how much phosphorus I'm getting. I have to make different food choices than I would normally like to make! For example, I should choose a Popsicle instead of ice cream, a bagel instead ofbiscuits, and gelatin instead of pudding. I have to be careful of sodium and potassium as well. I also take 1500 mg of calcium with Vitamin D every day and so far, my annual bone density tests have not shown any osteoporosis, even though I know that having kidney disease can weaken my bones.

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