Did you know that there are both primary and secondary causes of Osteoporosis?
Most people are familiar with the causes of PRIMARY OSTEOPOROSIS which are the result of the normal aging process.
It is an unfortunate fact of the normal aging process that from our 30’s on, the rate of bone formation never quite keeps up with that of normal bone resorption. Hence we are always facing a net loss of bone density unless we take measures to support bone-building and slow down the rate of bone resorption as much as possible.
Another example of PRIMARY OSTEOPOROSIS is the loss of bone mass because of the hormonal changes that accompany the aging process.
Although the decrease in estrogen associated with menopause for women is understood to be a risk factor for osteoporosis, the decreasing levels of testosterone in men also make them at risk for bone loss. Due to their larger skeletons which provides up to 20% greater bone mass and less abrupt loss of sex hormones, bone loss in men often starts later in life and progresses more slowly. With the relative rapid loss of estrogen during menopause, women are going to experience acceleration of bone resorption and subsequent loss of bone. It’s estimated that women lose about 20% of their existing bone mineral density in the first 5 – 7 years after menopause. And unfortunately, this rate of bone loss is not accompanied by an equitable increase in bone formation. So, the result is a net loss of bone density. Remember that healthy bone metabolism relies on the intricate balance of bone resorption and bone formation happening at similar rates.
As opposed to the primary causes of osteoporosis due to normal aging process and loss of hormones, the causes of SECONDARY OSTEOPOROSIS are the result of underlying or coexisting medical conditions and/or the use of certain medications that cause an acceleration of the bone loss compared to bone building phases of bone metabolism. This imbalance between the loss of old bone and the production of new bone leads to a lower bone turnover rate. The result is a loss of bone density.
An in-depth review of how various medical conditions actually contribute to the loss of normal bone remodeling is beyond the scope of this post. But here’s a list of medical conditions that can contribute to the acceleration of bone loss:
Hormonal imbalances like hyperparathyroidism, hyperthyroidism, conditions that result in decreased estrogen & testosterone levels not associated with normal aging
Auto-immune diseases like rheumatoid arthritis, lupus, celiac disease, ankylosing spondylitis, multiple sclerosis (MS)
Gut imbalances like gastro-esophageal reflux disorder (GERD), inflammatory bowel disease (IBD), small intestinal bacterial overgrowth (SIBO)
Metabolic dysfunction like Type 2 diabetes, chronic kidney disease, liver disease
Certain cancers like multiple myeloma
And disordered eating like anorexia nervosa and bulemia
Various medications can also increase one’s risk to developing secondary osteoporosis:
Medications that influence the endocrine system
Glucocorticoids, frequently referred to as steroids
Medications for both hyperthyroidism and hypothyroidism
Medications that suppress normal estrogen or testosterone production
Medications used to control glucose metabolism in Type 2 diabetes
Medications that affect the kidneys
Medications that belong to the family of loop diuretics
Medications that act on the central nervous system (brain and spinal cord)
Anticonvulsant/antiseizure medications and antidepressants.
Medications that affect the gastrointestinal tract
Proton pump inhibitors (PPIs) often recommended to manage reflux or gastro-esophageal reflux disease (GERD)
There are many other drugs that can impact bone health, but those listed above are the key offenders.
As a clinician, I find that oftentimes the impact on bone health due to these secondary causes of osteoporosis are frequently overlooked unless they are causing blatant pain, discomfort or dysfunction. Its not uncommon that many are unaware of the potential adverse effects of the medications that they are taking. And if you are dealing with serious health issues, oftentimes you get caught up in the immediacy and urgency of managing your care and it’s understandable that thinking about the long-term consequences, like your bone health, may not be a high priority in the moment.
What can be done?
Consider working with a practitioner who can help you explore your options to addressing the underlying cause(s) of your medical condition. In doing so you may not be as dependent on medications or at least may be able to lower your dose of medication. And you will have the opportunity to address the underlying cause(s) of your health issue instead of merely managing symptoms.
For example, if you’ve gone to your doctor’s office with a complaint of frequent indigestion or heartburn you’ve probably gotten a diagnosis of reflux or GERD. As a result, you may have left with a prescription for a medication to prevent or lower acid production in the upper GI system, like Prilosec, Nexium, Prevacid, Protonix or AcipHex. These are different brand names for a class of drugs known as protein pump inhibitors, or PPIs. Short-term use of this medication often times doesn’t cause long lasting bone health issues however for many people they are advised to stay on the medication indefinitely and sometimes for several years. Now you must be concerned about potential bone loss.
Do you know that making some dietary changes and improving digestion can significantly reduce your need for these medications? Unfortunately, most people prescribed this class of medication are not informed of the changes they can make to improve their situation and reduce the need for the medication. Consider use of this medication if you must to manage immediate discomfort and disruption to daily life but its use should be short-term while you investigate and adopt a change of habits that could make the need for these medications completely unnecessary.
But what if conditions are such that you are unable to reduce or eliminate the use of certain medications or the co—existing health condition is not amenable to resolution? Then your focus ideally, is to shift to adopting modifiable lifestyle habits that support healthy bone remodeling as much as possible.
We are not powerless! Addressing the primary & secondary causes of osteoporosis can significantly impact our bone health. The good news, here, is that making healthy changes to support your bone health will also benefit your overall health and well-being.
Want to learn more? Join me at the next FOUNDATIONS OF BONE BUILDING WEBINAR or the BONE BUILDER MASTER CLASS (also, sign up for the Harbor Healthy Lifestyle Blog for updates).
