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SECONDARY OSTEOPOROSIS - OTHER MEDICAL CONDITIONS AND TREATMENTS MAY BE PUTTING YOU AT RISK!

You should be aware that among the lesser-known risk factors for osteoporosis are a variety of other medical conditions that are known to compromise bone mass. In some cases, these conditions -- and/or the medications used to treat them - are the cause of osteoporosis. In others, they contribute to or complicate osteoporosis that developed on its own. Sometimes it's difficult to determine which of these is the case. Osteoporosis that occurs as a result of another medical condition or long-term drug therapy is known as "Secondary" osteoporosis.

Here are some of the medical conditions that may commonly cause or contribute to osteoporosis:

  • Asthma. It's not this condition itself that may compromise your bone mass, but rather the corticosteroid drugs often used to treat it. Long-term use of these medications interferes with calcium absorption and bone formation, and also triggers your body to remove calcium from your skeleton. The drugs also reduce the level of sex hormones in your body, which normally has a protective effect on your bones.

  • Autoimmune disorders. These include rheumatoid arthritis, lupus and inflammatory bowel disease (e.g. Crohn's disease, ulcerative colitis). These conditions are also commonly treated with corticosteroid therapy (see Asthma) -- and/or with immunosuppressive drugs that can have a similar negative effect on calcium absorption and bone formation.

  • Epilepsy. Again, it's the medication that causes the problem -- in this case, certain anticonvulsant drugs, which are also known to contribute to bone loss.

  • Gastrointestinal disorders. If you have a "malabsorption" syndrome such as celiac sprue disease, you have a reduced ability to absorb certain nutrients -including calcium - and therefore are at increased risk of developing osteoporosis. Even if you are simply lactose intolerant, your risk increases - so you should be careful to substitute non-dairy sources of calcium in your daily diet.

  • Inactivity or immobilization. Since weight-bearing activity is absolutely key to bone health, any medical condition that requires you to be inactive places you at increased risk for osteoporosis. Those on prolonged bed rest are especially at risk for loss of bone mass, and anyone with spinal cord injury typically experiences significant bone loss.

  • Nutritional deficiency. People whose diets are lacking in calories and calcium - such as those suffering from anorexia nervosa or bulimia, and alcoholism - are at increased risk for secondary osteoporosis. Heavy drinkers tend to have depressed levels of Vitamin D in their blood, and that situation inhibits calcium absorption. And it is also quite common for alcoholics to be deficient in magnesium, which may also play a role in bone loss.

  • Organ transplantation and-some forms of cancer. That's because immunosuppressive drugs are a common treatment in these situation.

Other medical conditions that may increase your risk of developing secondary osteoporosis include thyroid disorders, endometriosis, kidney or liver disease, early menopause due to surgery and Type I diabetes.

If you are affected by any of these conditions or circumstances, it is especially important to be attentive to maintaining your bone health. That means talking to your doctor about bone-density testing and asking to have the lowest effective dose of bone-depleting medications prescribed. Also, make sure to get plenty of calcium and Vitamin D on a daily basis through diet and supplementation - and, as possible, engage in regular weight-bearing exercise to help maintain bone strength.

What is Osteoporosis?

Literally "porous bones," osteoporosis sets in later in life when bones begin to lose density. As the bones weaken, the chance of fractures increases. Hips, wrists, and vertebrae in the spine are especially vulnerable.

While hips, wrist, and other fractures occur due to a fall or other impact, vertebrae commonly break during routine activities such as bending or lifting, and can lead to severe back pain. Or, they may crumble painlessly, with loss of several inches in height or a deformed, outwardly curved spine (dowager's hump) as the first visible sign of damage. As fragility increases, self esteem, confidence, and independence can shrink along with height.


How Can Osteoporosis Be Limited?

Bones may not seem like dynamic, changing tissues, but they are. The body adds new bone tissue until about age 30, at the same time tearing down bone tissue in a natural process. It is the balance of these opposite processes that determines bone density.

Throughout childhood, the balance tips towards the positive side as the body steadily accumulates bone, using calcium in the diet as the building block. By their 30's, a person has as much bone as they ever will. In scientific terms, they have achieved "peak bone mass."

After 30, bone is re-absorbed by the body at about the same rate it is created, and usually there's no net gain or loss.

Later in adulthood, the process that breaks down bone tissue dominates. In a sense, the body starts making withdrawals from its "bone bank." Now osteoporosis becomes a potential problem, especially in women during the first years of menopause, when bone loss speeds up.

Two important ways to limit the severity of osteoporosis are by attaining optimal peak bone mass in the first two to three decades of life, and minimizing the rate at which bone is lost in later years.

What is the role of insufficient calcium in the development of Osteoporosis?

Our bodies must maintain a constant level of calcium to function. Unfortunately, we excrete calcium normally every day. When we don't replace it daily, our body steals calcium from our bones, weakening them overtime-- a process that can contribute to the development of osteoporosis.


Build A Retirement Fund for Your Bones

Because the patterns of reforming and resorting bone often vary from patient to patient, experts believe a number of different factors account for this problem. Important hormones, such as estrogen, parathyroid, and vitamin D, and blood factors that affect cell growth are involved with this process. Changes in levels of any of these factors could play a role in the development of osteoporosis.

Osteoporosis Risk Factors

  • Female

  • Aging

  • Menopause or estrogen loss in women

  • Small frame, thin build

  • Caucasian and Asian races

  • Calcium-poor diet

  • High fiber intake

  • Lack of weight-bearing exercise

  • Inactive lifestyle

  • Smoking

  • Excessive use of alcohol

  • Family history of fractures

  • Certain medical conditions and medications

What Is Osteoporosis?

The Bones

The skeleton has a dual function. It provides structural support for muscles and organs and also serves as a depot for the body's calcium and other essential minerals, such as phosphorus and magnesium. The skeleton holds 99% of the body's calcium; the one-percent remaining calcium is freed to circulate in the blood and is essential for crucial bodily functions, ranging from muscle contraction to nerve function to blood clotting.

Like the body's other organs, bone tissue is constantly being broken down and reformed again. This turnover is necessary for growth, for repair of minor damage that occurs from everyday stress, and for the maintenance of a properly functioning body. The breakdown, or resorption, of the skeleton is done by cells known as osteoclasts, which are formed from certain types of blood cells. These cells dig holes into the bone, releasing the small amounts of calcium into the bloodstream that are necessary for other vital functions. Cells called osteoblasts, which are produced by bone cells, then rebuild the skeleton -- first, by filling in the holes with collagen and, then, by laying down crystals of calcium and phosphorus. Each year, approximately 10% to 30% of the adult skeleton is remodeled in this way. The osteoclast/osteoblast balance is controlled by a complex mix of hormones and chemical factors.

Osteoporosis

Osteoporosis is a disease of the skeleton in which the amount of calcium present in the bones slowly decreases to the point where the bones become brittle and prone to fracture. In other words, the bone loses density. Osteoporosis is diagnosed when bone density has decreased to the point where fractures will happen with mild stress, its so-called fracture threshold. There are two primary kinds of osteoporosis: type I and type II.

Type I, or high turnover, osteoporosis occurs in some women between the ages of 50 and 75 because of the sudden postmenopausal decrease in estrogen levels, which results in a rapid depletion of calcium from the skeleton. It is associated with fractures that occur when the vertebrae compress together causing a collapse of the spine and fractures of the hip, wrist, or forearm caused by falls or minor accidents.

Type II, or low turnover, osteoporosis (also known as age*related or senile osteoporosis) results when the process of resorption and formation of bone are no longer coordinated, and bone breakdown overcomes bone building. This occurs with age in everyone to some degree. Type II osteoporosis affects both men and women and is primarily associated with leg and spinal fractures. In older women, both type I and type II osteoporosis may occur.

The determining factor for the actual existence of either type I or type II osteoporosis is the amount of calcium left in the skeleton. Someone who has exceptionally dense bones to begin with will probably never lose enough calcium to reach the point where osteoporosis occurs, whereas a person who has low bone density could easily develop osteoporosis despite losing only a relatively small amount of calcium.

What Causes Osteoporosis?

Until a person is around 40, the process of breaking down and building up bone by osteoclasts and osteoblasts is a nearly perfectly coupled system, with one phase stimulating the other. As a person ages, however, this system breaks down and the two processes become out of sync. The reasons for this are not clear. Some individuals have a very high turnover rate of bone; some have a very gradual turnover, but the breakdown of bone eventually overtakes the build-up.

Some Lifestyle Factors May Compromise Bone Health

The lifestyle choices that you make may have an adverse effect on the condition of your bones.  That's what experts on bone health have learned from a variety of recent research studies.  Here are some factors that have been associated with bone loss:

  • Smoking. Tobacco is a known bone robber. It depletes your body of important bone-building nutrients. It decreases blood levels of estrogen, which normally has a protective effect on your bones. It may cause changes in your liver that interfere with your body's ability to utilize Vitamin D for bone formation. And it increases the level of toxic substances in your body, which may interfere with calcium absorption. Smoking also hampers bone self-repair, making it more difficult for fractures to heal.

  • Alcohol. Excessive consumption may interfere with absorption of calcium and other nutrients that are essential for bone formation, as well as your body's metabolism of Vitamin D. Heavy drinkers also tend to have poor dietary habits and often are deficient in nutrients that are important for bone health. The effects of moderate drinking are less clear, although some studies suggest that even this may have a damaging effect on your bones.

  • Stress. When prolonged, stress is believed to affect the functioning of your endocrine system and may lead to excessive excretion into your urine of calcium and other nutrients important for bone health.

  • Dieting. Unhealthy weight-loss methods such as crash- or starvation-diets and binge eating are increasingly commonplace today, and for some women are a lifelong practice.  Unfortunately, a deficiency in essential bone-building nutrients tends to accompany this. Low nutrient intake usually results in low bone mass!

If any of these contributing factors apply to you, making changes in your daily living patterns may be very beneficial to your bone health.

Eliminating or reducing your use of tobacco and intake of alcohol... lessening or learning to better manage your stress... using only nutritionally-sound weight-loss methods and becoming more physically active will all be helpful in maximizing your overall health and the health of your bones. And, as always, it is important to continue to emphasize adequate daily intake of calcium through diet and supplementation.

Bone-Depleting Drugs
Which ones are they? What can you do if you must take them?

A major but often overlooked cause of osteoporosis is a group of prescription medications that, when used on a long-term basis, may decrease bone mass and bone strength. These drugs are usually necessary treatment for a serious or chronic health condition, and may be the only way to manage that condition. In many cases they are life saving or vital for maintaining quality of life. But in the process of treating one condition, these drugs may cause another one: osteoporosis.

Which ones are they? What can you do if you must take them- on a long-term basis? How can you minimize the risk?

The use of bone-depleting drugs is quite prevalent. According to Dr. Lawrence Raisz, head of the Division of Endocrinology and Metabolism at the University of Connecticut Health Center, there are hundreds of thousands of people who are taking ther.

Drugs called "corticosteroids" that are used to treat conditions like arthritis, asthma, liver disease, Iupus, Crohn's disease, multiple sclerosis and glaucoma are, by far, the number one category of bone depleters.  Corticosteroids are also used following organ transplantation, and in conjunction with chemotherapy to treat some types of cancer.

The next most common categories of drugs that compromise bone mass are anticonvulsants (used to prevent seizures due to epilepsy or head injury) and thyroid hormone. Other bone-. compromising drugs include antacids that contain aluminum, some anti-cancer drugs and cyclosporine A (commonly used after organ transplantation).

These drugs come in many forms and are known by a variety of generic and brand names, so be sure to ask your doctor if you are being treated for any of these conditions and are not sure if your medication falls into one of these categories.

If you are taking any of these medications, there are some things you can do to help minimize their effect on your bones. According to Dr. Raisz, "The most important thing is to find a doctor who will pay attention to this problem, monitor your bone density if you're at high risk and use a variety of preventative measures." These include asking your doctor for the lowest possible dose that is effective in controlling your condition, making sure you get plenty of calcium and Vitamin D on a daily basis and exercising regularly to help maintain bone strength. Dr. Raisz recommends 1,000 mg. of calcium daily for pre-menopausaI women and 1,500 mg. after menopause.

For more detailed information on bone-depleting drugs, contact the The National Osteoporosis Foundation (NOF) at (202) 223-2226 and ask for your free copy of their informative booklet "Medications and Bone Loss."