Many chronic medical conditions can contribute to drastically low bone density. Some interfere with bone metabolism directly. Some impair your ability to absorb and use the nutrients you need for healthy bones. Some require medication that can damage your bones even as it addresses your other concerns (see section on medications).
Anorexia and other eating disorders increase your risk of low bone density, no matter what your age. For one thing, anorexia almost always has amenorrhea (no periods)—meaning low estrogen levels—associated with it. For another, taking in too few calories means by definition that you are not getting enough of the nutrients that are so important to bone health. Finally, anorexia is most common in girls and young women during the years when bone growth should be its fastest, meaning there’s a strong likelihood peak bone density will never be reached. That is, when women who had eating disorders early in life go into the accelerated bone loss of menopause, they will be starting with a sizable disadvantage.
Anorexia and eating disorders are complicated to treat and potentially life-threatening. One component of treatment you might consider is taking birth control pills to supply the estrogen your body isn’t making (think of it as a form of hormone replacement therapy).
High blood sugar levels, as in diabetes, inhibits the absorption of calcium, and long-term uncontrolled diabetes increases your risk of osteoporosis. It may be that insulin has a role in bone breakdown that contributes to that increase in risk. Diabetics have, on average, bone mass 10 percent lower than you would otherwise expect.
Other endocrine diseases, including Cushing’s syndrome, hyperparathyroidism, hyperthyroidism, and thyrotoxicosis, are major culprits—and the treatment can also be problematic. Anything that lowers your sex hormones (hypogonadism)—for men or women—will also raise your risk of osteoporosis. Increased risk of osteoporosis and fractures also accompanies chronic irritable bowel syndrome, celiac disease, scoliosis, jaundice, hypertension (high blood pressure), rheumatoid arthritis, cirrhosis, hyper-cortisolism, removal of the small colon, chronic lung disease, and removal of part or all of the stomach. All these conditions change your metabolism, and so alter your body’s nutritional requirements and demands and interfere with absorption of nutrients. You then may either have a higher requirement for calcium and other key nutrients for bone health that you are not meeting, and/or you may not be absorbing and using what you do take in.
Some people with kidney stones seem to be at higher risk for low bone density. If the stones contain calcium, the usual recommendation is to decrease the amount of calcium in your diet in order to lower the levels in your urine. But along with hindering stone formation, less calcium will also hinder bone formation. Sometimes diet changes do not affect how much calcium is excreted, and that indicates a different kind of problem. It is a sign of calcium imbalance, which your body addresses by taking calcium out of the bones to meet its needs. That’s obviously not good for your bones, and if, on top of that, you are restricting your calcium intake, your risk of osteoporosis climbs higher still.
Being bedridden for an extended time, or spending a long period of time getting all your nutrients through a tube or IV, for any reason, causes excess bone loss. Complete inactivity over time doubles the amount of calcium you excrete.
And anything that gives you impaired balance or coordination, making you more likely to fall or have some other sort of accident (for instance, the very common “postural hypotension”— light-headedness as you stand up as the result of a sudden drop in blood pressure), increases your risk of fractures, no matter what the status of your bones. Dementia is also a risk factor, probably because it affects the way you eat and increases the risk of falling.
Be sure to talk to your doctor about any steps you can take to avoid or counteract any negative impact on your bones. Generally, if you are dealing with any of these issues, you should be screened earlier than the average recommendation, and medical follow-ups should include bone density monitoring. Good diet and exercise habits and calcium supplements—as described later in this book—will be even more important for you than they are for people without these additional complications.
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