While osteoporosis is not necessarily a killer disease, there are certain conditions that increase risk of bone fracture, and ultimately such loss of quality of life that the combination of osteoporosis and underlying health issues can pose serious risk to a patient’s life span.

For instance, the risk of osteoporosis is higher in people who have certain medical problems, including: Celiac disease; Inflammatory bowel disease; Kidney or liver disease; Cancer; Multiple myeloma; Rheumatoid arthritis.

Co-morbidities can present insidious opportunities for developing osteoporosis; in turn bone thinning can increase the complexity and morbidity risk of certain diseases. There are a number of conditions that may raise your risk for osteoporosis and increase the risk of bone loss and fractures, even in younger people. If you suffer from any of these conditions, your doctor will likely recommend you take calcium and Vitamin D, and possibly other medications, and will advise you follow other preventive measures.

Various co-morbidities and effects on the bones

Sarcopenia and osteoporosis: These are often termed as osteo-sarcopenia. They are both age-related and represent a progressive decline of the bone-muscle unit – the causes of which are multifactorial. Lack of physical activity and inappropriate nutrition play pivotal roles. These conditions often coexist, primarily affecting the older population and are responsible for serious clinical, societal, social, and financial burdens.
Sarcopenia is characterized by a gradual and generalised wasting of muscle mass, strength, and loss of physical performance.
Osteoporosis is described by low bone mass and microarchitectural damage to bone tissue, resulting in increased bone fragility and vulnerability to fracture.

Menopause: The co-morbidity profile varies widely across postmenopausal women with osteoporosis, and co-morbidities often adversely affect the management of osteoporosis. Osteoporosis severity is increased not only by conventional risk factors, but also by a number of conditions, including: inflammatory bowel and joint diseases with or without glucocorticoid therapy; breast cancer and prostate cancer treated with chemotherapy or hormone therapy; diabetes; and celiac disease. These co-morbidities should be taken into account when evaluating the fracture risk and making treatment decisions.

Rheumatoid arthritis: This is a key auto-immune disease of the joints, and has been strongly linked to osteoporosis. Because the disease causes pain and loss of movement, patients tend to be less active, which can also weaken bones.

Auto-immune disorders: The problem with autoimmune disorders is that there are circulating chronic inflammatory factors that can make people more prone to bone loss, such as lupus and multiple sclerosis. A common treatment for autoimmune disorders is taking steroid medications to reduce inflammation, but steroids can weaken bones.

Digestive issues: People with gastrointestinal disorders may also have issues with digesting food and absorbing enough of the nutrients that help rebuild bone. Those with Celiac disease, for example, have problems absorbing nutrients, including calcium and vitamin D. Two autoimmune diseases of the GI tract—Crohn’s disease and ulcerative colitis—carry a one-two punch. They reduce absorption of nutrients needed to maintain healthy bones, plus they’re often treated with steroids, which can also cause bone loss.

Diabetes: People with both Type One and Type Two diabetes run a higher risk of fractures. Chronic high blood sugars damage bones, but it’s not yet clear how. Some research has shown that bone rebuilding is suppressed.

Hyperthyroidism: When the thyroid gland produces too much thyroid hormone, this can lead to weak muscles and fragile bones. Another less known condition is called hyperparathyroidism. We have four tiny parathyroid glands, which sit behind the thyroids in the neck. They produce parathyroid hormone, which regulates calcium levels in the blood. If they become hyperactive, your body draws too much calcium from bones, and this can result in bone loss.

Amenorrhoea: If you suffered from amenorrhoea—defined as missing three or more monthly periods in a row—you may be at increased risk of developing osteoporosis later in life. The missed periods may be a warning sign that you have low estrogen, which could lead to premature menopause. Other factors that may cause missed periods include extreme thinness and excessive exercise. Talk to your doctor if you miss your period for three months in a row.

Sedentary living and weight gain: Osteoporosis can be disabling and limit your physical activity. In turn, loss of activity – or an enforced sedentary lifestyle – can cause you to gain weight, which increases stress on your bones. And then, gaining weight can have the effect of increasing your risk of other problems such as heart disease and diabetes.

Hip fractures: Osteoporotic hip fracture remains a leading cause of morbidity and mortality in the older population where this condition often causes functional disability, thus increasing the risk of mortality.

No matter the disease or cause of fragile bones, be aware that practicing a physically active lifestyle will see you maintaining a healthier life all round. A balanced diet and nutrition, along with good sleep quality, calcium and Vitamin D supplements, and stress management, is always recommended. Exercises, including aerobic, resistance, balance, and co-ordination training, is advised to enhance strength, balance, posture, gait, and ultimately reduce the risk of falls.

Bones are with you all your life. They’ve got your back. No matter your health issues, always love your bones!

NOFSA (National Osteoporosis Foundation South Africa)

NOFSA is the only non-profit, voluntary health organisation dedicated to promoting lifelong bone health. We focus on reducing the widespread prevalence of osteoporosis while working to find a cure for the disease, and by supporting research and developing programmes of education and advocacy.

Find out more about our work at: www.osteoporosis.org.za