The following are brief explanations regarding the main red flags that people need to be aware of to assess if they are at risk of bone loss (osteopenia and/or Osteoporosis) and of breaking multiple bones.

Most people are not aware of the secondary effects of broken bones and how dangerous they can be. Therefore, it is essential that everyone check to see if they are at risk, as in many cases bone loss is preventable.

Note: There is a lot of misinformation on the internet about alternative treatments to manage bone loss. Osteopenia and Osteoporosis are diseases which need to be treated by a medication or treatment that has been proven by scientific research to work. The Irish Osteoporosis Society are the National experts on bone loss and do not ever recommend that a person treat their bone loss alternatively.

Some factors are much higher risk than others.

There are factors that determine a person’s risk of developing Osteoporosis and there are factors that place a person at higher risk for a fracture (broken bone). These may overlap but are not necessarily the same.

Research shows that most fractures occur within the moderate to marked osteopenia range. It is essential that the cause/s of your bone loss be found and addressed, as well as your Osteopenia/Osteoporosis. If you have a condition or are on a medication that is not listed here, please check with your doctor to see if it causes bone loss.

Genetic – Family History

Research shows that 80% of a person’s bone is influenced by genetics, especially in laying down the amount of bone during childhood.

A broken bone due to a trip and fall in an adult

It is not normal at any age to break a bone from a trip and fall, from a standing position or less. Any adult who has broken a bone under these circumstances should be considered to have Osteoporosis, unless proven otherwise.

A broken bone due to a trip and fall in a child

As children’s bones are not fully developed, it is quite common for children to break bones. If a child does break a bone, it is important to find the cause/s and rule out Osteoporosis.

Upper, middle or low back pain

If a person has upper, middle or low back pain, and they have risk factors for bone loss, a vertebral fracture (a broken bone in your back) should be ruled out. This can be done either by a DXA scan with an LVA (Lateral Vertebral Assessment) as part of a DXA scan, if this is available or by a plain lateral X-ray. The LVA should be done if the patient has lost height, postural changes, a hump has developed or has back pain.

Loss of height

Loss of height is a sign that the person may have  fractured vertebrae (bone/s in spine). It should not be considered normal aging for a person to lose height as they age.

Dowagers Hump on upper back

If it is due to Osteoporosis, the vertebrae in the spine are collapsing and unless treatment is initiated the person is at high risk for additional fractures within 6 to 12 months, which is known as the “Domino effect”. This also can place an older person at a high risk to fall, as their centre of gravity has changed, due their head/posture leaning forward.

Risk of a fracture

As a person’s age, their risk of falling increases and therefore, also their risk of breaking a bone/s. The following place a person at a higher risk of a fracture:

  • History of prior falls
  • Muscle weakness
  • Walking impairment
  • Balance affected
  • A person’s age
  • Those who use an assistive device, e.g. a stick or a walking frame
  • Blindness or visual impairment
  • Cognitive impairment

Please see the fall prevention section for further information.

Steroids

Increase bone loss, especially during the first six months of treatment.

Past or present eating disorder

These include Anorexia, Bulimia, frequent dieting and/or over exercising.

Impaired mobility (bed bound or wheelchair) for 6 weeks or longer

When a person is non-weight bearing there are no stresses put on the bone, which is necessary for bones to stay strong and healthy, therefore bone loss occurs. If this happens during pre-puberty / teenage years it can significantly decrease the amount of bone laid down.

Multiple Sclerosis

If mobility (walking/weight bearing) is affected, bone may not be stimulated, and treatment is usually steroids, which causes bone loss.

Parkinson’s Disease

If mobility (walking/weight bearing) is affected, bone may not be stimulated, which can result in bone loss.

Underweight for your height

This can place a person at a higher risk than those who are at a normal weight for their height.

Not enough calories for amount of exercise

If a person is not taking in enough calories to exercise, this will cause bone loss, usually due to low levels of sex hormone levels, which can also affect fertility.

Physiological Stress

Inadequate nutrition, poor absorption, excessive exercise, inadequate rest periods or excessive competitions can lead to physiological stress. This affects sex hormones, which can increase bone loss and may also lead to increased cortisol levels, which also cause bone loss.

Psychological stress

Due to any cause, particularly if it is associated with inadequate nutrition and poor absorption, will often result in increased cortisol and prolactin levels in the blood, which can cause bone loss.

Cortisol

High levels of cortisol can increase bone loss, usually seen in people with: Cushing’s Syndrome; a person on steroids, such as Prednisolone; athletes who are overtraining. Those going through separations, divorces, financial stress, high stress family issues can also produce high levels of cortisol.

Hyper-Prolactinaemia

High levels of prolactin, decreases sex hormone levels which can affect bone.

Acromegaly

This is an endocrine disorder, which is due to an increased secretion of growth hormone after puberty, which results in skeletal changes which may place a person at risk of Osteoporosis.

Cushing’s Syndrome

This is an endocrine disorder which is associated with increased levels of cortisol, which can result in increased bone loss.

Hyperparathyroidism

This causes an increase in the secretion of the parathyroid hormone, which can cause an increase in bone loss. It can either be primary or secondary.

Primary hyperparathyroidism

This is due to excessive secretion of the parathyroid gland.

Secondary hyperparathyroidism

This may be the result of severe renal disease or low levels of vitamin D.

Hyperthyroid

Excessive thyroxine can increase bone loss.

Hypothyroid

Excessive Eltroxin can increase bone loss.

Any type of Turner’s Syndrome

Only one X (XO) instead of 2 X (XX)
Results in low oestrogen levels, which may affect bone.

Klinefelter’s Syndrome

Extra X chromosome in males (XXY), no sperms and may have low levels of testosterone which may affect bone.

Vegetarian

If daily amounts of calcium, Vitamin D and protein are not met, bone loss may occur. Increased intestinal motility (diarrhoea) can affect hormones, which can affect bone.

Excessive Fibre

Over 40 grams a day can increase intestinal motility (diarrhoea) which can affect hormones, which can increase bone loss.

Vegan

If daily amounts of calcium, vitamin D and protein are not met, bone loss may occur. Increased intestinal motility (diarrhoea) can affect hormones, which can increase bone loss.

High Caffeine Intake

Increased calcium excretion in urine, can cause the body to take calcium from the bone.

Intolerance to dairy products

Can result in low levels of calcium and increased parathyroid activity and therefore bone loss can occur.

Low daily Calcium intake

If a person is not getting enough calcium in their daily diet, the body will start to take it from bone. Calcium is also important for the normal working of muscles and nerves.

Vitamin D

You need Vitamin D to absorb Calcium, low levels of vitamin D can result in high parathyroid hormone levels, which can increase bone loss.

Smoking

Increased risk of bone loss due to toxins which can affect bone.

Excessive Alcohol

May cause dietary and liver problems and low levels of sex hormones, which can affect bone.

Gastrectomy

May lead to a difficulty in absorption of nutrients, which could then place a person at risk.

Small bowel resection

May lead to a difficulty in absorption of nutrients, which could than place a person at risk.

Coeliac disease

Due to the problem with absorption, bone loss can occur.

Crohn’s disease

The disease itself places a person at risk and the main treatment for it is steroid based, which can affect bone.

Ulcerative Colitis

Due to the problem with absorption and treatment, bone loss can occur.

Haemochromatosis

Excessive iron is deposited in liver and other organs, which may result in low levels of sex hormones, which can affect bone.

Liver disease

As the metabolism of sex hormones are affected, this may increase the risk of Osteoporosis.

Primary Biliary Cirrhosis

Affects liver and hormones which can affect bone.

Kidney disease

Can sometimes cause secondary Hyperparathyroidism, which can cause bone loss.

Bone Marrow Disorders

Multiple Myeloma, Systemic Mastocytosis, disseminated carcinomatosis, all may increase bone loss.

Rheumatoid Arthritis

Steroids and the inflammation from the disease itself can affect bone.

Connective Tissue Disorders

May have abnormal bone collagen which can increase a person’s risk.

Osteogenesis Imperfecta

A genetic abnormality which affects collagen in the bone, characterized by bones that break easily, often from no apparent cause.

Marfan Syndrome

May have an increased risk due to abnormal collagen.

Metabolic Disorders

Such as Homocystinuria are extremely rare, due to an enzyme deficiency, which may affect collagen metabolism, and therefore place a person at risk of developing Osteoporosis.

Ehlers-Danlos Syndrome

This is a rare skin disorder, that is usually treated with steroids which can affect bone.

Polymyalgia

It is a connective tissue disease, which results in pain in muscles and is often associated with low levels of vitamin D. Steroids is one of the treatments for this disease which can affect bone.

Systemic Lupus

Steroids are one of the treatments for this disease, which can affect bone.

Scoliosis

It is an abnormal curvature of the spine which may predispose a person, as the person’s bones already have an issue and can result in reduced mobility.

Diabetes

Those with poorly controlled diabetes appear to be at a higher risk especially those with peripheral neuropathy.

Epilepsy

Anticonvulsants may affect calcium absorption and the circulating levels of vitamin D in the blood.

Cystic Fibrosis

Steroid Treatment can affect bone.

Prolactin Raising drugs

High levels of prolactin, results in reduced secretion of the sex hormones, oestrogen and progesterone, which can affect bone.

Medications for Depression

Some medications for depression may increase the levels of prolactin in women and men. This can result in menstrual disturbances in women and loss of libido in men. Please check with your doctor.

Aromatase inhibitor

These are used in the treatment of cancer of the breast and cancer of the prostate, to decrease sex hormones levels, however they can both affect bone.

GnRH analogues

Are sometimes used for the treatment of cancer of the prostate, cancer of the breast in females and endometriosis in females. It decreases the libido in males and females, which could place them at risk of bone loss.

Organ transplant

The treatments are usually immunosuppressants and steroids which both affect bone.

 

Additional Risk Factors for Women

If your first period was after age 15
Late production of sex hormones, can affect bone.

A woman going through the Menopause
Levels of oestrogen drop which can affect bone.

An early menopause (under 45 years)
Levels of oestrogen drop which can affect bone.

Surgical menopause, an ovary/ovaries removed or hysterectomy
Oestrogen levels will drop which can cause bone loss.

Depot Provera
Contraceptive which affects bone and can increase risk of Osteoporosis, especially if taken during the adolescent years when bone is being formed.

Pre-menstrual tension
Is usually the result of low progesterone levels which may affect bone.

Irregular periods or loss of periods for more than 4 months – other than pregnancy
This can be a sign that your sex hormones may be out of balance.

Additional risk factors for Men

The Most common cause in Males is Testosterone Deficiency
Low levels of Testosterone = Hypogonadism

Hypogonadism
When a person experiences one or all of the following: loss of sex drive, loss of erections, depression or fatigue

Testes removed
This may cause low levels of testosterone which may affect bone.

Mumps after puberty
This may cause low levels of testosterone which may affect bone.

Injury or infection to testes
This can cause low levels of testosterone which may affect bone.

The following medications/treatments may increase bone loss

Chemotherapy
Toxic effect on tissues, results in low hormone levels.

Radiation
Toxic effect on tissues, result in low hormone levels.

Thyroxine
Increases metabolism and bone loss.

Excessive Eltroxin
Increases metabolism and bone loss

Corticosteroids
For example Prednisolone, Prednisone, Cortisone, Delta Cortril can affect bone.

Aromatase inhibitors
Aromatase inhibitors decrease sex hormones in females with breast cancer, such as Arimedex and GnRh analogues for prostate cancer in males, which affect bone.

Anticonvulsants
Some anticonvulsants decrease calcium absorption which will affect bone.

Post Organ Transplant Therapy
Toxic effect on tissues, may result in low hormone levels which affect bone.

Chronic Heparin
Increased bone loss due to activity of osteoclasts, which remove bone.

Warfarin
Increases bone loss.

Antipsychotic medications
Some increase prolactin levels in the blood, which affects bone.

Long Term Lithium Therapy
May increase bone loss.

Calciuretic Diuretics (water pills)
Some of these can affect bone.

If you are on any medication or have a condition that is not listed above, please check with your doctor to see if it can put you at risk of bone loss.

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