What are the risk factors which can be influenced?
1.) Chronic Inactivity
Insufficient physical activity is the single most important risk factor for osteoporosis. This could be due to plain laziness or a forced paralysis after a spinal injury or weightlessness in Astronauts. The issue is, gravity helps, and doing activities resisting gravity strengthens bones!
Interestingly, a lot of research on bone marrow density(BMD) is carried out in space. Remember, astronauts do a lot of research in space but to prevent osteoporosis, they do a special set of exercises as there is no gravity in space !! (Gravity is good !)
2.) Excessive sports in females
May sound paradoxical! But in later life that’s exactly what happens chiefly due to a strict control in diet and weight, causing loss of all body fat(and hence oestrogen storage sites !). The lack of oestrogens then causes irregular menstrual periods or maybe total stoppage of periods. Muscle mass increases with regular exercises and in some cases regular consumption of oral contraceptives does help, but the eventual trade-off is in the negative.
3.) Low body weight
The new fad amongst young ladies! The reality is “slim women, thin bones”. Underweight women have a high risk of fractures, while overweight women are rarely affected by oestrogens since excess weight strengthens bones and excess fat stores oestrogens, the bone strengthening hormone. That does not mean, we are advocating being overweight! Overweight people have more osteoarthritis! We recommend the “ideal” body weight depending on the height/age/sex.
Importantly, if on a diet please supplement with necessary nutrients (all) and strengthen your muscles and bone with exercises.
4.) Low calcium intake over a long-term period
stimulates the parathyroid hormone which in turn releases calcium from the bones causing osteoporosis.
A chronic state of depression causes osteoporosis indirectly due to
High level of stress hormones
The drugs themselves
Lack of appetite/inadequate nutrition
Reduced physical activity
6.) Cigarette smoking “the bone terrorist”
Nicotine smoking reduces bone marrow density. Men and women who are chronic smokers have a significantly higher rate of vertebral and hip fractures due to osteoporosis.
Various contributing mechanisms are:-
Nicotine inhibits oestrogen secretion, stimulates its breakdown in the liver and also causes early menopause.
Smoking depletes the body of Vit C which is necessary for bone building and it also increases the toxic load of cadmium and lead which interferes with calcium absorption.
Lastly, smoking directly reduces the blood supply of bones and also inhibits osteoblasts, the bone-forming cells.
7.) Excessive Alcohol
Modest alcohol intake(60 ml/day) increases oestradiol concentration and is thus bone protective, but alcoholism increases the risk of osteoporosis substantially. This is due to :
Accompanying poor nutrition
Decreased calcium absorption
Lowered Oestrogen levels
Lowered testosterone levels
Chronic Alcoholics are 5-10 times more prone to fractures!!
8.) Nutritional deficiency
Nutrition is an essential factor in maintaining bone health
Minerals: Calcium- Calcium supply is a lifelong issue. If there is a constantly decreased calcium intake, it stimulates the parathyroid hormone to release calcium from the bones, which maintains the blood calcium level but drains the bones of calcium causing osteoporosis. Phosphorous, Magnesium, Zinc, Manganese, Copper, Boron, and silica are other minerals necessary.
Vitamins D,C,K,B6, B12, Folic acid
Essential fatty acids
Healthy bones require healthy eating habits !!
Early menopause (Natural or Surgical) is an important risk factor.
Insufficient testosterone in men leads to early osteoporosis ( as in chronic alcoholism, Anorexia Nervosa, and Hypogonadism).
Many drugs weaken bones, most importantly steroids (taken for bronchial asthma, allergies, rheumatic, hematological, intestinal, and immunological diseases and post transplantation). A therapy of more than one year is significant.
Some other common drugs are
Lithium (for depression)
Isoniazid ( for tuberculosis)
Carbamazepine/Dilantin( for Convulsions)
Antacids containing Aluminium
Tell your doctor if you are already on some medication. It matters!
In the next issue of KUC Times, we shall discuss the clinical symptoms and signs and the relevant investigations needed for an accurate diagnosis of osteoporosis.