Osteoporosis Causes

In Episode #3 of the Bone Coach Podcast, we’re talking about the causes of osteoporosis and what you can do to stop or prevent further bone loss.

We’re going to define osteoporosis, talk about peak bone mass, we’ll explore what causes osteoporosis (both primary and secondary causes), and discuss important lab tests and resources.

The topics we discuss include:

• Osteoporosis definition

• Understanding peak bone mass

• Primary & Secondary Osteoporosis

• Estrogen and postmenopausal bone loss

• Medications that can damage bone including Glucocorticoids, SSRI’s, antacids, and more.

• Gastrointestinal diseases including Crohn’s Disease & Ulcerative Colitis

• Autoimmune disease including: Celiac Disease, Ankylosing Spondylitis, Lupus, Rheumatoid Arthritis, Graves’ Disease

• Hyperparathyroidism

• Hypercalciuria

• Diabetes

• Thyroid conditions including hyperthyroidism

• Cancers: Breast cancer, Multiple Myeloma, Leukemia and others

• Pregnancy and Lactation-Induced Osteoporosis (PLO)

• Hypogonadism and low testosterone

• How Diet & Lifestyle could have impacted your bones growing up, how they can impact them now, plus tips on how to start improving.

Resources Mentioned

--->Claim your FREE 7-Day Osteoporosis Kickstart (everything you need to know to start building stronger bones now)

Cyrex Array #3: Consider ordering if negative for Celiac Disease, but want to understand if wheat/gluten is still negatively stimulating your immune system.

Cyrex Array #4: Consider ordering if positive for Celiac Disease, you have gone gluten-free, and you suspect you are cross-reacting to other foods, including gluten-free foods.

Parathyroid.com: Great Resource to learn more about hyperparathyroidism.

23andMe: Interesting and helpful information about your health and ancestry. Really nice app. Simple, at-home, saliva test. About $200. You can take your raw data from 23andMe (very easy to do) and plug it into Strategene.

Strategene: Learn if you have copies of the MTHFR gene which could be contributing to elevated Homocysteine levels. Also learn other info about your genetics, like defects that could be impacting your detoxification capabilities, Omega 3 fatty acid conversion, Vitamin D status, and more.

My top sources of Omega 3 fatty acids: fish oil capsules, sardines, anchovies, fresh or canned wild-caught sockeye or pink salmon. Canned sockeye salmon with bones is also a good source of calcium.

Methylated B Vitamins (good if you have poor digestion, don’t eat meat, or find out you have MTFHR deficiency): Vitamin B9 Folate (5-MTHF) & Vitamin B12 (Methylcobalamin)

Pregnancy & Lactation-Induced Osteoporosis (PLO) Support Group Contact Information: pregnancyosteoporosis@gmail.com. This is a free group for women with PLO. They take privacy very seriously. If you've just been diagnosed with PLO, this could be a helpful resource for you in working through the mental and emotional aspects of the condition.

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Full Transcript:

Welcome welcome to Episode 3 of the Bone Coach Podcast. Kevin Ellis here. For today’s episode, we’re talking about the causes of osteoporosis.

We’re going to define osteoporosis, talk about peak bone mass and we’ll explore what causes osteoporosis (both primary and secondary causes).

Since I’ll be covering quite a few possible causes in this episode, if any of these stand out to you, especially if you’re driving and listening, just make a mental note and you can come back and listen again or you can go online and read the full transcript later.

You’ll be able to find all of the show notes, downloads, and everything I talk about today at bonecoach.com/osteoporosis-causes

Really, this is the episode to help you start identifying potential causes of your osteoporosis which could be related to nutritional deficiencies, lifestyle factors, certain medical conditions, and even medications.

Now, if you’re like me, when you hear a bunch of new terms, or diseases, or conditions, and even the word “cancer,” that could be related to your osteoporosis, it may trigger a little anxiety in you...but realize that ALL of these don’t apply to you, and some of these are rare conditions.

Also remember that the point of educating ourselves is to become empowered. And to become empowered we need to have knowledge and awareness of what could be contributing and even what could have contributed (past tense) to us developing osteoporosis.

In the prior episode, episode 2, we talked about bone remodeling. It’s a process that takes place throughout our entire lives and it balances bone resorption and bone formation.

When we have a negative balance, where resorption exceeds formation, you’ll have a net bone loss that can lead to osteoporosis.

Osteoporosis Definition

Osteoporosis, literally means "porous bone." It’s a disease characterized by too little bone formation, excessive bone loss, or a combination of both. ¹ In osteoporosis, bone quality and bone density are reduced, which increases the risk of fracture.

Understanding Peak Bone Mass

But what’s important to keep in mind...if you are diagnosed with osteoporosis or low bone density, it does NOT mean you are actively losing bone.

You may just not have achieved peak bone mass in your younger years.

The National Institutes for Health suggests thinking about your bones as a bank account, where you make “deposits” and “withdrawals” of bone tissue.

“During childhood and adolescence, we have much more bone deposited than withdrawn, so the skeleton grows in both size and density. Up to 90 percent of peak bone mass is acquired by age 18 in girls and by age 20 in boys.” Which makes our youth ideally the best time to “invest” in our bone health…

That doesn’t mean, however, that now is too late to invest in your bone health. It’s never too late.

But, if you had an eating disorder, poor nutrition, low calcium and vitamin d intake, if you smoked or drank excessively, if you led a sedentary lifestyle, or took certain medications when you were younger, those all could have prevented you from achieving peak bone mass or a sufficient bone bank account. ²

Typically, peak bone mass, is achieved by the late 20s or by the time you turn 30.

After that, bone resorption can begin to exceed bone formation.

Osteoporosis Causes

There are two main types of osteoporosis: primary and secondary. There’s also idiopathic osteoporosis in which the cause is unknown, but we’re going to touch on primary and focus mainly on secondary causes.

Primary Osteoporosis

There are two distinct types of primary osteoporosis:

Type 1 primary osteoporosis typically occurs in postmenopausal women, and it’s related to decreased levels of estogen. Estrogen has a protective effect on bone. When estrogen levels decrease (as they do during menopause), it causes an increase in the activity of osteoclasts, the cells that break down bone.

For those of you who are interested in understanding a little more of why this happens, a lack of estrogen is associated with an increased release of cell-signaling proteins called cytokines. Interleukin (IL)-1 and IL-6 specifically are the cytokines that stimulate osteoclasts which in turn increases bone breakdown. ³

Type 2 primary osteoporosis, known as senile osteoporosis. This affects both men and women. In this case, bone loss is not attributed to increased osteoclast activity, and the cause of bone loss is not known. This typically occurs in men and women over the age of 75 and may be more directly related to the aging process.

Now, if you don’t fall into those two categories, or if you’re still trying to figure out what could be causing, or could have caused your low bone density, that’s what we’re going to discuss with secondary osteoporosis.

Secondary Osteoporosis

Secondary osteoporosis is the consequence of specific conditions, disorders, diseases, medications, or behaviors that cause low bone mineral density (BMD), either by preventing you from reaching peak bone mass or by increasing rates of bone loss. ⁴

Secondary osteoporosis can affect both adults and children. This is why even people who are in their 20’s, 30’s (I fall into this category), 40’s and 50’s can develop osteoporosis.

So, first I’m going to touch on those specific medications, diseases, or conditions that could be a secondary cause of osteoporosis.

Then I’m going to talk about the lifestyle practices and behaviors that also could have contributed or could currently be contributing to your low bone density.

Let’s start with medications, because these are going to come up a few different times throughout this podcast.

Medications

Glucocorticoids

Glucocorticoids are steroid medications designed to suppress inflammation. They mimic natural steroid hormones produced by your body. They are often used to treat conditions like asthma and autoimmune diseases like rheumatoid arthritis. Two of the more common drug names are Prednisone and cortisone. There are others too.

Bone loss is a common side effect of these medications for a few reasons:

• They reduce the gastrointestinal absorption of calcium and increases urinary excretion of calcium, which leads to a calcium deficit. ⁵

• Glucocorticoids act directly on osteoclasts to increase their life span and reduce bone density.

• They further disrupt the bone remodeling process by decreasing bone formation. ⁶

• And, in men, they can decrease testosterone levels, which I’ll touch on a little more shortly.

So there are a lot of ways that Glucocorticoids can negatively impact your bones.

Immunosuppressive Drugs

Other immunosuppressive drugs used to suppress, or reduce, the strength of the body’s immune system, like calcineurin inhibitors, can also contribute to bone loss. ⁷

Selective Serotonin Reuptake Inhibitors (SSRI’s)

SSRI’s are a class of drugs that are typically used as antidepressants. There was one review of 19 studies on the effect of SSRIs on bone that indicate they have a negative effect on bone mineral density (BMD) and increase the risk of fracture. ⁸

Antacids

These are drugs that reduce the production of, or increase the suppression of, stomach acid. This includes Proton Pump Inhibitors (PPI’s) like omeprazole, Nexium, Prevacid and it includes H2 receptor antagonist drugs like ranitidine (Zantac).

I took Proton Pump Inhibitors for a number of years to suppress my stomach acid because like most people who take PPI’s, I mistakenly thought I had too much stomach acid. This is a problem because we need stomach acid to break down and extract nutrients from our food (e.g. amino acids, calcium, magnesium, iron, b12).

Studies indicate that long term use could lead to decreased intestinal absorption of calcium resulting in negative calcium balance, increased osteoporosis, development of secondary hyperparathyroidism, increased bone loss and increased fractures. ⁹

Other drugs that can contribute to secondary osteoporosis...

Barbiturates

Class of drugs that act as a central nervous system depressant and are used for the treatment for anxiety, insomnia, and seizure disorders.

Anticonvulsant medications

Lithium

Used to treat many psychiatric disorders

Diseases

There are a variety of gastrointestinal, endocrine, autoimmune, and other diseases that can contribute to bone loss.

Gastrointestinal disease

There are several key nutrients that are important for bone health: amino acids, calcium, magnesium, phosphorous, vitamins D and K. Diseases of the stomach and intestines can lead to osteoporosis when they impair absorption of these nutrients.

This would be your Crohn’s disease, Ulcerative Colitis, Celiac Disease.

Crohn’s disease and ulcerative colitis are also known as inflammatory bowel diseases (IBD).

IBD is often treated with the glucocorticoid medications we talked about earlier (such as prednisone or cortisone) to reduce inflammation. These drugs, as I shared, interfere with the development and maintenance of healthy bones and can lead to bone loss.

Crohn’s disease

Crohn’s disease is an inflammatory bowel disease that causes chronic inflammation of the gastrointestinal tract. It can affect any part of the GI tract, from the mouth to your anus.

Symptoms include: persistent diarrhea, rectal bleeding, urgent need to move bowels, abdominal cramps and pain. It can lead to a loss of appetite and weight loss. It can cause low energy and fatigue.

If you suspect you have Crohn’s, you would speak with your gastrointestinal doctor about getting tested with blood and stool lab tests and possibly X-rays, endoscopy or other imaging. ¹⁰

Ulcerative Colitis

Ulcerative colitis is a chronic disease of the large intestine, in which the lining of the colon becomes inflamed and develops tiny open sores, or ulcers. This is the result of an overactive immune system response.

Similar to Crohn’s, loose and urgent bowel movements, bloody stool, and abdominal cramps and pain are symptoms.

Blood and stool lab tests plus imaging are what your doctor can use to help you determine this.

Celiac Disease

I have celiac disease and osteoporosis, so I can tell you firsthand this is an important one to rule out. Let me first start by touching on autoimmune disease. Autoimmune disease is when your body attacks its own healthy tissues.

Celiac disease is an autoimmune disease that damages the small intestine after ingesting gluten. ¹¹ The healthy tissues that are destroyed are called villi. Villi are tiny, hair-like projections that line the small intestine and help us absorb vitamins, minerals, and nutrients.

Many bone healthy nutrients, like calcium, phosphorus, vitamin D, are absorbed in the upper portion of the small intestine which commonly suffers damage. We need these nutrients for healthy bones.

Long-term malabsorption of these key nutrients can lead to osteoporosis.

If you’re unsure if you have Celiac Disease, you can get tested for it. At a minimum you’ll want to get tTG-IgA, serum Total IgA, IgG and IgA antigliadin antibodies. A complete celiac antibodies profile, like this one from Labcorp includes tTG IgA, tTG IgG, DGP IgA, DGP IgG, EMA IgA, and Total IgA.

Get these tests done BEFORE removing gluten from your diet. Otherwise, you won’t have enough antibodies present for the test to be accurate.

Even if you’re negative for celiac disease (get the actual numbers from your doctor...don’t let them just tell you) you may still have problems with wheat and proteins that resemble gluten.

Personally, I recommend avoiding gluten altogether.

But, if you’re negative for celiac disease and want to know if wheat/gluten is still promoting inflammation in your body and negatively stimulating your immune system, consider ordering a Cyrex Array #3 test. This test looks at the different components of wheat that cause problems and will tell you if you should avoid it.

If you do have celiac disease, and have gone gluten-free, your body may still be reacting to other foods (even gluten-free foods) as if they were gluten. This is called cross-reactivity and it could be contributing to nutrient malabsorption. Common cross-reactive foods are dairy, coffee, corn, rice, quinoa, oats, eggs, and others. If you suspect you’re cross-reacting with other foods, it would be well worth ordering the Cyrex Array #4 test.

Both the Array 3 & 4 tests are blood tests you order online and the tests are shipped to your home. In the kit will be instructions on where/how to find a lab near you to draw and ship back.

Last note I’ll say about Celiac Disease is that if you know someone who has it, let them know they should consider having a DEXA scan. Personally, I think this should be the standard of care for anyone newly diagnosed.

Other Autoimmune Conditions

Ankylosing spondylitis

Is considered both an autoimmune-type of arthritis and a chronic inflammatory disease that primarily affects the spine and vertebrae. It can lead to severe, chronic pain and discomfort and can cause some of the vertebrae in your spine to fuse leading to hunched-forward posture.

Osteoporosis is common in ankylosing spondylitis because of both systemic inflammation and decreased mobility. ¹²

Rheumatoid arthritis

Rheumatoid arthritis (RA) is an autoimmune disease in which the body’s immune system mistakenly attacks the joints. This creates inflammation that causes the tissue that lines the inside of joints (the synovium) to thicken, resulting in pain, swelling, and stiffness in and around the joints…especially in the hands and feet.

If inflammation goes unchecked, cartilage and the bones themselves can also be damaged.

A common medication used to treat RA: Glucocorticoids. We’ve already talked about how they can trigger significant bone loss. The bone loss is most pronounced in areas immediately surrounding the affected joints. ¹³

Lupus

Lupus is an autoimmune disease that can cause damage and inflammation in various parts of the body including the joints, skin, kidneys, heart, and lungs.

Individuals with lupus are at increased risk for osteoporosis for a number of reasons.

Glucocorticoid medications prescribed can trigger bone loss. Pain and fatigue can result in inactivity. Studies also show that bone loss in lupus may occur as a direct result of the disease. And, about 90 percent of the people affected with lupus are women, who are already at increased risk for osteoporosis. ¹⁴

Other Conditions That Could Be Contributing to Bone Loss

Hyperparathyroidism

Now there are two types of hyperparathyroidism. Primary and secondary.

Primary hyperparathyroidism is caused by a benign tumor.

Secondary hyperparathyroidism is caused by low blood calcium levels and a nutritional deficiency in Vitamin D.

But let’s start with an overview of the parathyroid glands.

Parathyroid glands are four small glands located in the neck behind the thyroid. Their primary role is to control the calcium levels in our blood, in our bones, and throughout our body.

Why is that their primary role? Because calcium is the most important element in our bodies. It provides electrical energy for our nervous system. It helps our muscles contract. And it provides strength to our skeleton.

You know where the majority of calcium in our bodies is stored? In our bones. We are continually putting calcium into, and taking calcium out of, our bones in small amounts...with the sole purpose of keeping our calcium levels in the blood at the correct level.

In primary hyperparathyroidism, one of these parathyroid glands go bad, the majority of the time it’s just one (about 90%), it just grows big (develops a benign tumor) and makes too much parathyroid hormone (PTH).

This excess hormone goes to the bones, takes calcium out of the bones, and puts it in your blood.

This can lead to osteoporosis and can worsen your bone density if that benign tumor is not removed.

If you’re looking at your blood test results and you see high blood calcium (even in the higher range of “normal”), low vitamin D, AND have high parathyroid hormone (PTH) at the same time, this could be a good indicator of primary hyperparathyroidism.

If you have high parathyroid hormone, low vitamin D, and low serum calcium, this could be a good indicator of secondary hyperparathyroidism and a nutritional deficiency in calcium and vitamin D.

In either case, you should work with someone experienced with hyperparathyroidism. Regardless of where you’re located, I think you can get a consult with the Norman Parathyroid Center in Tampa, FL if you want to work with someone who specializes in this.

That’s a quick overview of hyperparathyroidism. There’s much more to it, and it’s not always clear cut, and that’s one of the reasons one of the experts I’ll be having on an upcoming show is the medical director of the Norman Parathyroid Center in Tampa, FL to go into this in much greater detail and to address some of the most commonly asked questions.

For now, though, you can find more info at parathyroid.com.

Breast Cancer

We talked about estrogen’s role in bone health in type 1 primary osteoporosis with post menopausal women.

Estrogen has a protective effect on bone. Reduced levels of estrogen trigger bone loss.

Due to treatment medications or surgery, loss of ovarian function and, consequently, a drop in estrogen levels can result. Women who were premenopausal before cancer treatment may go through menopause earlier than those who have not had breast cancer. ¹⁵

Hypercalciuria

Hypercalciuria is a disorder that causes too much calcium to be lost through the urine, which makes the calcium unavailable for building bone, and can be an indicator of bone loss.

Susan Ott, M.D., who specializes in research and clinical treatments for osteoporosis. She points out that “most agree that urine calcium should be lower than 300 mg/day when the dietary intake is within the recommended range (1200 mg/day)”. ¹⁶

Common causes include primary hyperparathyroidism, hyperthyroidism, Paget disease, myeloma, malignancy, immobility, sarcoidosis, renal tubular acidosis, and drug-induced urinary calcium loss such as that seen with loop diuretics. ¹⁷

Diabetes

Insulin is a hormone produced by the pancreas. It’s responsible for moving glucose (blood sugar) from the bloodstream into the cells for energy.

Type 1 diabetes, is where too little or no insulin is produced due to the immune system damaging or destroying the insulin producing beta cells of the pancreas. This is an autoimmune condition that is often developed during childhood.

In Type 1 diabetes, too little or no insulin is produced due to the immune system damaging or destroying the insulin producing beta cells of the pancreas. This is an autoimmune condition that is often developed during childhood.

In Type 2 diabetes, the body produces insulin but not enough, and the body doesn’t respond properly to the insulin that is produced. This form of the disease is more common in people who are older, overweight, inactive.

Both can play a role in osteoporosis by reducing bone quality, increasing inflammation if not kept in check, preventing people from reaching peak bone mass (especially in type 1 diabetes), and increasing fracture risk. ¹⁸

Thyrotoxicosis

Thyrotoxicosis refers to having an excess of circulating thyroid hormones.

What causes it?

• Hyperthyroidism (overactive thyroid) occurs when your thyroid gland produces too much thyroxine (also called T4). Hyperthyroidism can be caused by an autoimmune condition called Graves’ disease or a toxic nodular goiter.

• Other causes could be:

• Thyroiditis (inflammation of the thyroid gland)

• Iodine-induced and drug-induced thyroid dysfunction

• Excessive intake of thyroid hormone in patients treated for hypothyroidism.

Thyrotoxicosis is diagnosed by lab tests that show raised thyroid hormone levels in the blood:

• Elevated T4 (thyroxine)

• Elevated T3 (Triiodothyronine)

• You’ll also have extremely low or undetectable Thyroid Stimulating Hormone (TSH)

It’s understood that even mild increases in thyroid hormone can contribute to the loss of bone mass. ¹⁹

Hypogonadism (men, low testosterone levels)

Hypogonadism refers to abnormally low levels of sex hormones including low testosterone. It’s well known that in women loss of estrogen causes osteoporosis. Similarly, in men, reduced levels of testosterone may also cause osteoporosis.

Although it is natural for testosterone levels to decrease with age, there should not be a sudden drop in testosterone that’s comparable to the drop in estrogen experienced by women at menopause.

A few causes of low T could be the use of glucocorticoids (discussed above), cancer treatments (especially for prostate cancer), pituitary disorders, Kallman syndrome which is abnormal hypothalamus function, obesity, and chronic stress, and even overtraining can all affect testosterone levels.

Research suggests that estrogen deficiency may also be a cause of bone loss in men. ²⁰

Osteogenesis imperfecta

A genetic disorder characterized by bones that break easily, often from little or no apparent trauma. It’s caused by genetic defects that affect the body’s production of type I collagen.

Homocystinuria

This is a rare disease associated with osteoporosis where people have very high plasma levels of homocysteine. Homocysteine is an amino acid typically present in small amounts in all of our bodies’ cells, but it’s considered an inflammatory marker and has negative impacts on bone at high levels. ²¹

A more common reason why homocysteine could be elevated is due to Methylenetetrahydrofolate Reductase (MTHFR) Deficiency.

MTHFR is an enzyme that uses folate (vitamin B9) to support important processes in the body including an important chemical process called methylation but also for processing amino acids, specifically, converting homocysteine to methionine.

When you have a genetic defect in the MTHFR gene, it can lead to impaired function or inactivation of this enzyme, which results in mildly elevated levels of homocysteine. ²²

Now, you can find out if you have this defect through various at home testing. I personally used 23andMe which is an easy, at-home, saliva kit that you send off and it provides your genetic ancestry and health information in a really neat format that can be accessed through the 23andMe app. It’s also relatively inexpensive (about $200). To perform this test, it’s pretty easy. You provide a saliva sample in a tube and send it in the mail to a lab. Results take six to eight weeks.

If you want even more information to find out if you have some of the more common genetic defects people have, you can take that raw data from 23andMe and upload it into a tool called Strategene.

This can give you even more information on your personal genetics including detoxification, genes related to your ability to convert beta carotene (the plant form of vitamin A) into preformed vitamin A (retinol), your ability to convert ALA (the plant form of Omega 3) to EPA( the form of Omega 3 most available in fatty fish). I’m a poor converter of ALA to EPA and its why I get most of my Omega 3’s from fish oil, sardines, anchovies, and wild caught sockeye salmon.

It can even give you information on your Vitamin D receptor genes to let you know if genetics may be playing a role in your inability to maintain optimal 25-hydroxy vitamin D levels.

It’s been a helpful tool for me. I’ll link to both 23andMe and Strategene in the show notes.

But, anyway, back to homocysteine. Elevated homocysteine has been linked to lower bone mineral density. If you do find out that you elevated homocysteine, not related to Homocystinuria, eating a diet with folate rich foods (dark leafy greens, cruciferous vegetables, organ meats) and supplementing with the methylated, active forms of B vitamins like B9 (5-MTHF) and B12 (Methylcobalamin) could be helpful.

Pregnancy and Lactation-Associated Osteoporosis (PLO)

This a rare and severe type of osteoporosis that arises during pregnancy, after delivery, or during breastfeeding.

Women lose some calcium from their bones during a normal, healthy pregnancy and breastfeeding. But in women with PLO, that calcium loss leads to significant bone fragility, particularly in the vertebrae. They can have multiple spine or other fractures with little or no trauma.

If you do find out that you have PLO, head over to bonecoach.com/osteoporosis-causes and I’m going to link to the contact information for a free worldwide support group for women who have the condition, because I think it’s so important for these new moms to have not only physical support but also the mental and emotional support.

Other conditions

These are some other conditions I’m just going to briefly touch on, highlighted by the International Osteoporosis Foundation. ²²

Conditions that can cause secondary osteoporosis:

• Serious kidney failure

• Cushing's disease: an excess of blood cortisol levels caused by a tumor on the pituitary gland.

• Liver impairment

• Anorexia nervosa and bulimia: eating disorders

• Multiple sclerosis: autoimmune disease where the immune system attacks the protective sheath (myelin) that covers nerve fibers and causes communication problems between your brain and the rest of your body.

• Chronic obstructive pulmonary disease (a condition affecting the airways)

• Scurvy

• Gastric bypass surgery

Other hormonal causes

• Hyperthyroidism: an excessive secretion of the thyroid glands

• Hypercortisolism: elevated blood cortisol levels as a result of systemic illness or long-term use of oral corticosteroid

Other rare causes

• Pregnancy and Lactation-Associated Osteoporosis (PLO)

• Thalassemia: a hereditary form of anemia

• Multiple myeloma: a rare type of bone cancer where tumors develop within the bone and bone marrow. One of the ways to help identify this would be through a lab test called protein electrophoresis.

• Leukemia: cancer of the body's blood-forming tissues, including the bone marrow and the lymphatic system

• Metastatic bone diseases: when malignant tumor cells spread from one part of the body to another; the disease travels through the blood and settles in the bones

• Prostate cancer:

  • Studies show that men who receive hormone deprivation therapy for prostate cancer, where you’re depriving cancer cells of male hormones/androgens, have an increased risk of developing osteoporosis and broken bones. Testosterone as I mentioned earlier is one of those hormones that protects against bone loss. So, once these hormones are blocked, bone becomes less dense and can break more easily. ²³

Lifestyle Practices

The last thing I want to talk about is lifestyle practices. Now, these are things that you may still be doing today, but they also could have been major contributors to you NOT achieving peak bone mass in your younger years.

Excessive alcohol consumption

There’s a great deal of evidence that alcohol abuse may decrease bone density.

Smoking

Bone loss is more rapid, and rates of hip and vertebral fracture are higher, among people who smoke. Tobacco, nicotine, cadmium and other chemicals found in cigarettes may be either directly toxic to bone, or they may inhibit absorption of calcium and other nutrients needed for bone health. If you’re currently a smoker, quitting is something you’ll want to put at the top of your list.

Personally, I checked both of these buckets as contributors to my osteoporosis.

In my early 20’s, I was in the Marine Corps infantry, incredibly stressful job. When we’d go away on deployment, I’d smoke cigarettes...a lot of cigarettes. Which thinking about that now is disgusting and nauseating, but the combination of stress and boredom probably didn’t help the habit.

In celebration of returning home from deployment, I’m sure I had, and I’m sure there are some very incriminating pictures and stories out there, that could attest to my indulgence in way too much alcohol. Lessons learned.

Lack of Exercise

Our bones and our bodies need a physical stressor in the form of weight-bearing exercise, strength training, and leading active lifestyles to maintain and even build bone. If you didn’t lead an active lifestyle when you were younger, and you still don’t now, that could be a contributing factor.

Immobilization

Prolonged bed rest (following fractures, surgery, spinal cord injuries, or illness) or immobilization of some part of the body for an extended period of time, that can often result in significant bone loss, because we need weight-bearing activity to maintain healthy bones. Without it, bone density can decline rapidly.

Diet & Nutrition

When I was a young kid, I didn’t have the best diet. I grew up in the Midwest. I ate a lot of chips and crackers, and macaroni with Velveeta cheese, and canned vegetables devoid of nutrients, and I ate a bunch of candy, and drank a bunch of sugary soft drinks and sodas.

Sugar damages bone. Excessive carbohydrate intake damages bone.

Poor diet and nutrition could absolutely increase your risk and exacerbate low bone density...because it’s all about nutrients.

Not getting enough protein…protein makes up roughly 50% of our bone volume. We need a daily supply of dietary protein to maintain this bone. ²⁴

Not getting enough important nutrients like magnesium, vitamin D, vitamin K2, vitamin C, and others.

Not getting enough calcium, the primary mineral of our bones. The RDA recommendation is 1,000-1,200 mg for adults. ²⁵

Especially if you can’t tolerate dairy products, or have chosen a diet that eliminates dairy like paleo or vegan, for example, you may find it hard to figure out how to get enough calcium through your food.

Eating a diet rich in whole, unprocessed foods with lots of leafy greens, brightly colored vegetables, healthy fats, and lean proteins is all important for bone health. If your diet consisted of or still consists of heavily processed packaged foods with little to no nutritional value, that’s not helping your bones, and it’s likely doing more harm than good.

Your Next Steps

Now, we just covered a lot of information, I just touched on some pretty scary stuff...and it’s natural for our minds to shift to the worst case scenario.

Especially when you hear for the first time what all could be contributing to osteoporosis…

But keep in mind many of those are rare...especially the cancers. Remember, too, what we’re doing here...we’re building our knowledge base so we can be empowered to take charge of our health.

But, the very first question you need to answer is: Am I actively losing bone, or did I just not achieve peak bone mass? Or is it a combination of both?

Because if you are actively losing bone, you need to identify the underlying cause of bone loss. Otherwise, you will continue to lose bone.

In secondary osteoporosis, treatment may include treating the underlying cause of a disease or condition that may not yet be known.

When secondary osteoporosis is suspected, you need a thorough medical history, a physical examination, and laboratory testing.

• Hyperparathyroidism

• Hyperthyroidism

• Hypogonadism

• Diabetes

• GI Disorders

• Crohn disease & Ulcerative colitis

• Celiac Disease

• Primary biliary cirrhosis & Chronic active hepatitis

• Multiple Myeloma, Leukemia, Lymphoma

• Rheumatoid arthritis

• Renal Failure

• Vitamin D Deficiency. Everyone should be tested for this.

• ...and others

If and when abnormalities are detected in those tests, that’s when you should be seeking a referral to a specialist for further evaluation and specific treatment.

I think that’s it for this one...I’m your Bone Coach, Kevin Ellis, See you in the next episode!

[blogSourcesStart]

Sources

1 - https://www.bones.nih.gov/health-info/bone/bone-health/juvenile/juvenile-osteoporosis

2 - https://www.bones.nih.gov/health-info/bone/osteoporosis/bone-mass

3 - https://www.sciencedirect.com/topics/medicine-and-dentistry/primary-osteoporosis

4 - https://www.bones.nih.gov/health-info/bone/bone-health/juvenile/juvenile-osteoporosis

5 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3784314/

6 - https://www.ncbi.nlm.nih.gov/pubmed/9664068

7 - https://jasn.asnjournals.org/content/18/1/223

8 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3442753/

9 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2974811/

10 - https://www.crohnscolitisfoundation.org/what-is-crohns-disease/diagnosis-testing

11 - https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/celiac

12 - https://www.spondylitis.org/Ankylosing-Spondylitis

13 - https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/osteoporosis-ra

14 - https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/osteoporosis-lupus

15 - https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/osteoporosis-breast-cancer

16 - https://www.sciencedirect.com/topics/medicine-and-dentistry/hypercalciuria

17 - https://www.mdedge.com/ccjm/article/155188/nephrology/idiopathic-hypercalciuria-can-we-prevent-stones-and-protect-bones

18 - https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/diabetes

19 - https://www.ncbi.nlm.nih.gov/books/NBK285567/

20 - https://www.bones.nih.gov/health-info/bone/osteoporosis/men

21 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4425139/

22 - https://www.healthline.com/health/mthfr-gene#diet

23 - https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/osteoporosis-prostate-cancer

24 - https://academic.oup.com/ajcn/article/87/5/1567S/4650438

25 - https://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/

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