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Do you know why you have osteoporosis and bone loss?
Or have assumptions been made?
If you’re a woman, and you’re diagnosed with osteoporosis around menopause, you may just think (or you may have been told) it’s just a natural part of the aging process.
If you’re a younger man or woman and you’re unexpectedly diagnosed, you may not know why.
Both situations require further investigation…
AND thorough medical workups by your doctor (though rarely are they ever done properly).
The cause(s) of your osteoporosis may not always be clear… and there can be multiple causes.
Answering “Why do I have osteoporosis?” before doing anything else is critical for the long term health of your skeleton.
To help you better understand osteoporosis, I’m going to:
Define osteoporosis
Explain peak bone mass
Explore what causes the different types of osteoporosis (yes, there are different types)
Before I share any of this, though, I want you to keep something in mind…
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 (still important to rule out, but rare).
What we’re doing here is donning our detective hats and starting to figure out what could be the cause(s) of your osteoporosis and bone loss.
And as much as I care about you and your health, no one (not even your doctor) is going to care more about your health than you…
☝️ That is why we need to become educated, become empowered, and act like the CEO’s of our own health.
Let’s get to it 🕵️♀️…
Osteoporosis Defined
Osteoporosis, literally means “porous bone”…
It’s a disease characterized by too little bone formation, excessive bone loss, or a combination of both.
In osteoporosis, bone quality and bone density are reduced, which increases the risk of fracture.
Understanding Peak Bone Mass
One potential cause of osteoporosis is that you may 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”During childhood and adolescence, we have much more bone deposited than withdrawn…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.”
So, ideally the best time to “invest” in our bone health was in our youth…
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 and a sufficient bone bank account.
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.
That doesn’t mean, however, that now is too late to invest your bone health.
It’s never too late.
Different Types of Osteoporosis
There are two main types of osteoporosis: primary and secondary.
Primary Osteoporosis
Primary osteoporosis can be broken down into two distinct types:
Type 1 Primary Osteoporosis
Typically occurs in postmenopausal women and is related to decreased levels of estrogen…
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.
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.
If you don’t fall into either of these categories OR…
Even if you do, and you’re still actively losing bone and experiencing bone loss …
You’ll want to read about 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.
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 the specific medications, diseases, or conditions that could be a secondary cause of osteoporosis (shorthand version).
Then, I’m going to talk about the lifestyle practices and behaviors that also could have contributed (in the past)…
Or could currently be contributing (present day) to your low bone density.
Medications
Glucocorticoids
These are steroid medications designed to suppress inflammation in asthma and autoimmune disease.
Bone loss is a common side effect of these medications
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 long term use could lead to decreased intestinal absorption of calcium, increased osteoporosis, development of secondary hyperparathyroidism, increased bone loss and increased fractures.
Selective Serotonin Reuptake Inhibitors (SSRI’s)
SSRI’s are a class of drugs typically used as antidepressants.
A review of 19 studies on the effect of SSRIs on bone indicate their negative effect on bone mineral density (BMD) and increased risk of fracture.
Other drugs contributing to bone loss and osteoporosis
Barbiturates
Other Immunosuppressive Drugs
Anticonvulsant medications
Lithium
Gastrointestinal Diseases
This includes Crohn’s, Ulcerative Colitis, and Celiac Disease.
Diseases of the stomach and intestines can lead to osteoporosis when they impair absorption of bone-healthy nutrients like amino acids, calcium, magnesium, phosphorous, vitamins D and K, and others.
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.
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.
For both Crohn’s and UC, blood and stool lab tests plus imaging are what your doctor can use to help you determine this.
Celiac Disease
Celiac disease is an autoimmune disease that damages the small intestine when you ingest gluten.
Over time, this damage can prevent you from absorbing nutrients.
Long-term malabsorption of these key nutrients can lead to osteoporosis.
Signs and symptoms of celiac disease range from tiny red bumps on the skin (dermatitis herpetaformis), tingling or pain in the hands and feet, foggy mind, bloating, gas, diarrhea, and more…
Many celiacs have no gut distress but still incur the damage.
Other Autoimmune Diseases
Anklosing Spondylitis
AS 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.
Rheumatioid Arthritis
In RA, the body’s immune system mistakenly attacks the joints.
This creates inflammation that causes the tissue lining 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.
Glucocoriticoids are used to treat RA which can also lead to bone loss.
Lupus
Causes damage and inflammation in various parts of the body including the joints, skin, kidneys, heart, and lungs.
Glucocorticoids, again, are used as treatment.
Other Conditions Contributing to Osteoporosis
Diabetes
Type 1 and Type 2 diabetes can lead to reduced bone quality…
And can prevent people from reaching peak bone mass (especially in type 1 diabetes).
Breast Cancer
As mentioned earlier, estrogen has a protective effect on bone.
A drop in estrogen levels may occur after breast cancer treatment.
Hypercalciuria
Hypercalciuria is a disorder that causes too much calcium to be lost through the urine…
This makes it unavailable for building bone…and can indicate bone loss.
Susan Ott, M.D., an osteoporosis specialist, 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)”.
Hyperparathyroidism
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.
Primary hyperparathyroidism is caused by a benign tumor on one of those glands.
Secondary hyperparathyroidism is caused by low blood calcium levels and a nutritional deficiency in Vitamin D.
If your blood test results indicate high blood calcium (even in the higher range of “normal”), low vitamin D, AND high parathyorid hormone (PTH) at the same time…
This could be a good indicator of primary hyperparathyroidism.
If you have high PTH, low vitamin D, and low serum calcium…
This could be an indicator of secondary hyperparathyroidism and a nutritional deficiency in calcium and vitamin D.
Thyrotoxicosis
This is an excess of circulating thyroid hormone.
Often times the cause is hyperthyroidism from Graves Disease or toxic nodular goiter.
Other causes include thyroiditis, iodine or drug-induced thyroid dysfunction…
Or excessive intake of thyroid hormone in patients treated for hypothyroidism.
Hypogonadism
Low testosterone in men.
Causes of low T include glucocorticoids, cancer treatments, pituitary disorders, Kallman syndrome.
Other contributors can be obesity, chronic stress, and overtraining.
Osteogensesis 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
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.
Elevated homocysteine levels could also be related to the fairly common MTHFR gene mutation.
If you have MTHFR, make sure your B-vitamins are in the methylated active forms like B9 (5-MTHF) and B12 (Methylcobalamin).
Pregnancy and Lactation-Induced 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.
It can lead to multiple spine or other fractures with little or no trauma.
Other potential causes of bone loss:
. Serious kidney failure
.Cushing’s disease: excess of blood cortisol levels caused by a tumor on the pituitary gland.
.Hypercortisolism: elevated blood cortisol levels as a result of systemic illness or long-term use of oral corticosteroid
.Liver impairment
.Anorexia nervosa and bulimia: eating disorders.
.Multiple sclerosis: autoimmune disease where immune system attacks the protective sheath (myelin) that covers nerve fibers
.Chronic obstructive pulmonary disease: a condition affecting the airways)
.Scurvy
.Gastric bypass surgery
.Thalassemia: a hereditary form of anemia
.Multiple myeloma: rare bone cancer where tumors develop within the bone and bone marrow. Identified by protein electrophoresis lab test.
.Leukemia: cancer of the body’s blood-forming tissues, including the bone marrow and the lymphatic system
.Metastatic bone disease: 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
Now, we just covered a lot of potential causes of your osteoporosis….
Some of these sound pretty scary, I know…
And it’s natural for our minds to shift to the worst case scenario…
But keep in mind many of these are rare… and they don’t ALL apply to you (still important to rule out though)…
Remember, too, what we’re doing here…
We’re building our knowledge base so we can be empowered to take charge of our health and get answers.
The last piece I’ll touch on very quickly are lifestyle factors…
Excessive smoking and alcohol consumption…
Lack of exercise…
Long periods of bedrest and immobilization…
And poor diet and nutrition could all have played a role.
If any of these are still a part of your daily life today, you’ll need to make changes if you want stronger bones…
And I can help you with that, but we need to figure out this next piece first…
Are you actively losing bone and what’s causing that bone loss?
Now that you have a better understanding of what can cause osteoporosis…
It’s time to shift our focus to whether or not you’re actively losing bone…
Because if you are losing bone…
You need to figure this out, otherwise you will continue to lose bone… period.
Most of the people I speak with tell me their goal is to “reverse osteoporosis” or “build stronger bones”…
But we can’t start going up… until we stop going down. Right?
Many of them haven’t first answered these two important questions:
Are you actively losing bone?
What’s causing that bone loss?
If you don’t know the answer to either of these critical questions…
And you’re ready to figure out if, and why, you’re losing bone…
By: Steve
