So, we may know some basics about how to prevent osteoporosis such as consume more calcium rich foods (or take supplements), weight-bearing exercise, limit caffeine and alcohol and avoid smoking. But finding other causes are also important. Here are some secondary causes of osteoporosis:
1. Glucocorticoid Use- Chronic use of steroids are given to treat inflammatory conditions such as asthma, allergies, and autoimmune disorders (lupus, arthritis) to name a few. About 20% of people on long-term corticosteroid therapy suffer osteoporotic fractures. High dose use of steroid inhalers is also linked to bone loss. If you are on long-term steroid use (more than a few weeks), consider supplemental nutrients to limit bone loss induced by these medications. Microcrystalline hydroxyapatite (MCHC), calcium, and Vitamin D are important supplements while on these steroids.
2. Vitamin D deficiency- I have talked about this important hormone (yes..hormone, not a vitamin) in other blogs and more research is showing how common a deficiency this is in the general population. The prevalence appears to range between 9% and 50%. Vitamin D deficiency is associated with secondary hyperparathyroidism. The problem in treating this deficiency is that there is no general agreement as to what constitutes a sufficient 25-hydroxy-vitamin D level. The reference range in many labs is 20-100ng/ml. It appears that at least 35ng/ml is necessary for maximal intestinal calcium transport. I prefer a level between 50-60ng/ml. It is worth getting a level checked since there are so many symptoms of Vitamin D deficiency. Read my prior blogs on Vitamin D.
3. Celiac Disease- Somewhere between 9% and 12% of people with osteoporosis also have celiac disease. Conversely, about 50% of people with celiac disease have a low bone mineral density (BMD) and are at high risk for fracture. These patients have difficulty with calcium absorption as well as other important bone-building nutrients (there are 18 of them!). They tend to have Vitamin D deficiency. Women can also suffer from infertility and lack of mentrual periods. A stool test can be purchased on-line (Enterolab.com) that is very accurate in making the diagnosis. I feel it is even more accurate than the “gold standard” of an intestinal biopsy.
4. Androgen Deprivation Therapy- This is a common treatment for men with prostate cancer. After 10 years on androgen deprivation therapy, about 20% of men will experience a fracture. Slender white men are at greatest risk.
Ask your practitioner about additional testing if your bone mineral density test (DEXA scan) is abnormal. Testing for electrolytes, renal and liver function, a complete blood count, 24 hour urine calcium, 25-hydroxyvitamin D level, Testosterone and thyroid levels could help in diagnosing other causes of osteoporosis and help initiate treatment. Remember, this is a disease that affects both men and women.