You probably know some of the leading risk factors for osteoporosis -- being female and past menopause, smoking, or having a small frame. But did you know that some fairly common medical conditions are also among the causes of osteoporosis bone loss?
If you have one of these conditions, either because of the disease itself or because of the medications you have to take to manage it, you face an increased risk of developing osteoporosis:
1. Diabetes Mellitus and Osteoporosis
For reasons scientists still don't fully understand, people with type 1 diabetes tend to have lower bone density.
Studies show that people with type 1 diabetes may have low bone turnover and lower than normal bone formation.
"It seems that high blood sugar may shut down bone formation, just as with steroids," says Beatrice Edwards, MD, MPH, associate professor of medicine and director of the Bone Health and Osteoporosis Center at Northwestern University Feinberg School of Medicine. Since type 1 diabetes usually develops in childhood, when the body is still building bone, someone with type 1 diabetes may never have the opportunity to reach their peak bone density.
Even if their bone mass isn't that much lower than normal, people with both type 1 and type 2 diabetes have a much higher risk of fractures than other people, adds Edwards.
2. Lupus and Rheumatoid Arthritis
Nearly 3 million adults in the U.S. have either lupus or rheumatoid arthritis. Both of these diseases are autoimmune conditions, in which the body attacks its own healthy cells and tissues, causing inflammation.
Any chronic inflammatory disease can put you at greater risk of osteoporosis, says Edwards, because it appears to increase the rate of bone turnover, in which old bone is replaced with healthy new bone. People with both lupus and RA usually take corticosteroids for an extended period of time to manage their symptoms. Long-term use of steroids such as prednisone is also a leading cause of osteoporosis, possibly because they slow the activity of bone-building cells.
Lupus is a particular problem because it is common in women between the ages of 15 and 45 -- often during the peak bone-building years up to age 30. "Anything that impedes the growth of bone during these years puts you at greater risk for osteoporosis," says Edwards.
Hyperthyroidism occurs when the thyroid gland -- a small, butterfly-shaped gland at the base of the neck -- becomes overactive and produces too much thyroid hormone.
"Hyperthyroidism increases the number of bone-remodeling cycles you go through," explains Edwards. "And after age 30, every bone-remodeling cycle is inefficient. You lose bone mass rather than building it. So the more cycles you go through, the more bone mass you lose."
Hyperparathyroidism, a similar condition involving related, but different glands, also ups the risk of osteoporosis.
4. Celiac Disease
A number of digestive disorders, such as Crohn's disease, can be causes of osteoporosis. Perhaps the most common such cause, says Edwards, is celiac disease, an allergy to a protein called gluten that is often found in wheat products.
Left untreated, celiac disease can damage the lining of the digestive system and interfere with the digestion of nutrients -- including the calcium and vitamin D that are so important to bone health. So even if you're getting the recommended daily amounts of calcium and vitamin D in your diet, if you have celiac disease, you probably don't have enough of those nutrients in your system, and you likely have low bone density.
Asthma itself does not increase your risk of developing osteoporosis, but the medications used to treat it do. Approximately 20 million people in the U.S. have asthma, including some 9 million children under the age of 18.
Many people with asthma use corticosteroids -- such as asthma "inhalers" -- to help control their disease. During asthma attacks it is not uncommon to start drugs like prednisone for small periods of time. These are very effective in relieving the shortness of breath and wheezing that are common with asthma or emphysema, but they may also contribute to bone loss and osteoporosis.
"In addition to this, many young people with asthma may have more difficulty participating in some activities, which means they might not get as much weight-bearing exercise as they need to help build bone," says Andrew Bunta, MD, associate professor and vice chair of orthopaedics at Northwestern University Feinberg School of Medicine.
6. Multiple Sclerosis
Asthma and multiple sclerosis are two very different conditions, but there are very similar reasons why they both increase the risk of osteoporosis. Like people with asthma, people with multiple sclerosis take steroid-based medications to help manage their symptoms, and steroids are associated with bone loss. Since multiple sclerosis also affects balance and movement for many people, someone with MS may find it more difficult to get as much weight-bearing exercise as they need to in order to build and maintain bone.
"Anything that impedes your ability to walk accelerates bone loss," says Edwards.
If you have one of these conditions, how can you help protect yourself from osteoporosis? First, don't assume that your doctor will take care of it for you.
"When you are troubleshooting a primary condition like MS, asthma, or lupus, you're not thinking about the side effects. Osteoporosis can take a back seat," says Felicia Cosman, MD, medical director of the Clinical Research Center at Helen Hayes Hospital in Haverstraw, N.Y., and an editor of Osteoporosis: An Evidence-Based Guide to Prevention and Management. "That's understandable -- but you don't want osteoporosis to add more disability to an already disabling condition."
So if the doctor treating your celiac disease or rheumatoid arthritis hasn't already brought up osteoporosis with you, ask to discuss it. Depending on your age and your specific condition, you may have several options to help prevent osteoporosis symptoms:
- Get an early bone density test. Doctors don't usually recommend bone density tests for premenopausal women, but if you have one of these conditions, you may need to be monitored more closely, and treated for bone loss more aggressively.
- Push for more vitamin D and calcium in your diet, and supplement. Edwards recommends that people with conditions that accelerate bone loss get at least 1,000 to 1,500 milligrams of calcium and 400 to 600 international units (IU) of vitamin D from food and supplements. Look for low-fat dairy and fortified foods.
- Consider getting the vitamin D levels in your blood measured. "That's not a specific recommendation from the National Osteoporosis Foundation, but it makes so much clinical sense," says Cosman. "Because vitamin D levels vary so much between individuals, it's hard to know how much supplementation is needed to reach sufficient levels."