Health Conditions That Can Increase Your Risk of Osteoporosis

Throughout childhood and early adulthood, our bones do a really great job of staying healthy and strong. Old bone cells are constantly breaking down and new bone cells are growing. We can’t see or feel it, but this balanced process is what keeps our bones healthy and able to withstand the forces of day-to-day life, says Kendall F. Moseley, MD, assistant professor of medicine and medical director of the Metabolic Bone and Osteoporosis Center at the Johns Hopkins University School of Medicine. When the bones begin to break down at a faster rate than they grow back, osteoporosis can develop.

Osteoporosis is a condition that’s defined by a loss of bone density, resulting in weak and brittle bones that fracture easily. “It’s a silent disease—you don’t feel your bones thinning over time,” says Dr. Moseley. It can develop for many different reasons, but some people are at a higher risk than others. In fact, there are a handful of other medical conditions that can compromise this healthy bone-growth process and increase the chance that you’ll develop osteoporosis.

Osteoporosis risk factors

Osteoporosis affects an estimated 1.4 million Canadians, according to the International Osteoporosis Foundation, but women have a much higher risk of developing it than men. “One in two women over the age of 50 have an osteoporosis-related fracture in their lifetime,” says Ruban Dhaliwal, MD, MPH, director of the Osteoporosis Program at Upstate Medical University in Syracuse, New York. That’s because estrogen is important for maintaining bone density, and it decreases drastically around menopause.

Age is a risk factor for both women and men. “Until about 20 to 30 years of age, we have a net gain in bone density,” Dr. Moseley says. New, healthy bone is building at a faster rate than it’s breaking down. Then, somewhere around our 30s, we enter a maintenance phase, where we pretty much break even. Then, around age 50 for women, there is a steep decline in bone density as estrogen levels decrease. Men hit their steep decline a little later, closer to 70, when testosterone levels drop, Dr. Moseley says.

Other risk factors include having a small body frame, a family history of osteoporosis, and being white or of Asian descent, though people of all ethnicities can and do develop osteoporosis. Lifestyle factors that increase risk include smoking, drinking alcohol, poor nutrition (especially in childhood when the bones are growing the most), and being sedentary. “Regular physical activity is key to bone health,” Dr. Dhaliwal says. “Bones like weight-bearing exercise.”

Health conditions that increase osteoporosis risk

In a perfect scenario, we’d all follow that lifelong path of bone health. The thing is, many health conditions and medications can interfere with bone growth and cause you to lose bone density earlier and quicker than other people your age.

Below are the main medical conditions that are associated with an increased risk of osteoporosis. If you have any of these conditions, talk with your doctor about how you can monitor your bone health and decrease your risk of osteoporosis. They may want to regularly check your bone density with a DEXA scan (similar to an X-ray) and if necessary, can give you medications to help prevent further bone breakdown or even build the bones back up, Dr. Moseley says.

Chronic inflammatory disorders

Lupus, rheumatoid arthritis, Crohn’s disease, ulcerative colitis, hyperthyroidism, and pretty much any other disease that causes chronic inflammation, comes with an increased risk of osteoporosis, Dr. Moseley says. These conditions are caused by a glitch in the immune system that causes it to mistakenly attack healthy cells in the body. In many autoimmune conditions, the immune cells actually target the bones and contribute to bone breakdown, Dr. Moseley explains.

Beyond the direct impact on the bones of chronic inflammation, these conditions often cause chronic pain and can make regular physical activity difficult, further decreasing bone density. On top of that, inflammatory conditions are often treated with steroids, which are known to cause bone breakdown. “It’s kind of a double hit,” Dr. Moseley says.

“A steroid is a hormone,” Dr. Dhaliwal explains. “They’re important in our body but beyond a certain physiological normal, any hormone in excess is going to harm the body in one way or another.” Oral steroids (and some inhaled steroids) affect the bones cells directly, promoting cells that break down bone, called osteoclasts. Steroids also interfere with the body’s ability to use calcium, Dr. Moseley adds.

Other medications used to treat some autoimmune conditions like lupus and rheumatoid arthritis (such as hydroxychloroquine and methotrexate), can also decrease bone density, Dr. Dhaliwal says. Another class of drugs for these conditions, called biologics, may also affect the bones, though the data is mixed.

HIV/AIDS

Dr. Moseley adds that people with HIV/AIDS, which attacks the immune system, also tend to be at a higher risk of osteoporosis. Part of that is due to inflammation, but medications given for HIV/AIDS can also negatively impact the bones. Dr. Moseley also notes that people with HIV/AIDS tend to lose weight, which can further weaken bones.

Gastrointestinal disorders

Diseases that impact the gastrointestinal tract and interfere with the absorption of calcium and vitamin D can add to the breakdown of bones. Calcium is an essential building block for bones, and vitamin D is necessary for us to properly absorb calcium.

Celiac disease

Celiac disease, in which the body generates an inflammatory response in the small intestine when a person eats a protein in wheat called gluten, damages the lining of the small intestine over time. This leads to difficulty taking in vitamins and minerals, Dr. Dhaliwal says, including calcium and vitamin D. Being on a strict gluten-free diet can also make it harder to get all of the vitamins and minerals you need.

Crohn’s disease & ulcerative colitis

In addition to causing inflammation in the body, the digestive disorders known as Crohn’s disease and ulcerative colitis are associated with bone density loss because they interfere with proper nutrient absorption.

Eating disorders

Eating disorders like anorexia and bulimia can affect bone density in a few ways. First, these eating disorders lead to malnourishment, so it may be impossible to get enough of the nutrients needed to build strong bones, including calcium, protein, phosphorus, and vitamin D, Dr. Moseley says. “If you’re not consuming or absorbing these nutrients, your bones can’t be strong. It’s like trying to build a house out of straw.” This can be especially detrimental during the teenage years and early adulthood when bone mass should be growing at its highest rate.

On top of that, eating disorders can impact hormones and decrease estrogen levels, says Dr. Dhaliwal. This can further impede the growth of healthy bone mass. In addition, losing a lot of weight quickly results in loss of muscle mass, which leads to loss of bone density, too.

Endocrine disorders

The endocrine system is made up of glands throughout the body that produce and secrete essential hormones. The pancreas, thyroid, parathyroid, adrenals, ovaries, and testes are all glands in the endocrine system.

The hormones produced in the endocrine system work together in many ways, Dr. Dhaliwal says. “If you have excessive production of one hormone, that oftentimes leads to an imbalance in sex hormones,” resulting in lower estrogen in women and lower testosterone in men, which can further impact the bones.

Hyperthyroidism & hyperparathyroidism

The thyroid gland in your neck may be small but it has a big job, controlling numerous vital body functions. Having too many thyroid and parathyroid hormones puts your body in a “high-breakdown state,” says Dr. Moseley, because the hormones basically encourage cells that break down bone to be overactive. These conditions also cause chronic inflammation, adding to the impact on bone density.

Cushing’s disease

In Cushing’s disease, the adrenal gland produces too much cortisol. The same way taking steroid medications leads to bone breakdown, so can an overabundance of natural steroids made in the body. Cushing’s disease is rare, but any condition that leads to chronically high levels of cortisol can have the same impact. (Keep in mind that these strange symptoms can signal a serious disease.)

Diabetes

Type I diabetes, which is normally diagnosed in childhood, can interfere with healthy bone buildup throughout life, Dr. Moseley says. “The typical gain in bone density [during childhood] is blunted because of nutritional difficulties, growth issues, and low body weight.” High blood sugar also results in chronic inflammation, says Dr. Dhaliwal, which can further damage the bones. “In general, people with type I diabetes are prone to a higher risk of fracture compared to other people their age,” she adds. The reason isn’t super clear, and researchers are still trying to figure out exactly why that is.

Type II diabetes is also associated with a higher risk of fracture, though Dr. Dhaliwal notes that it’s not so much a result of bone density loss, but rather an issue with bone quality.

Cancer

Cancer can weaken the bones in multiple ways. “Cancer itself is an inflammatory disease,” Dr. Moseley says. Cancer treatments like radiation and chemotherapy can inadvertently kill healthy cells while also killing cancer cells, and side effects can cause loss of appetite and consequently, malnutrition and muscle mass loss, Dr. Dhaliwal says. “Vomiting may also limit the absorption of nutrients.” Steroids may also be taken for certain cancers.

Breast cancer in particular can have a big impact on bone health. “If a person is still menstruating and is diagnosed with an estrogen-sensitive cancer, the first thing that’s often recommended is ovary removal,” Dr. Dhaliwal explains. “That leads to early menopause.” Some breast cancers are treated with medications called aromatase inhibitors, which stop the production of estrogen, resulting in bone loss even if the ovaries aren’t removed. Also, these household products may be linked to breast cancer.

Men with prostate cancer may receive medication to decrease testosterone levels since the hormone is believed to promote the cancer. This can also lead to bone loss.

Finally, cancers in the blood and bone marrow, like leukemia, lymphoma, and multiple myeloma, can damage the bones depending on where the lesions form. The treatments for these types of cancers also often lead to bone loss, Dr. Dhaliwal says.

Liver and kidney disease

Advanced liver disease can make it hard for the liver to metabolize calcium and vitamin D, Dr. Moseley says. It also alters the metabolism of sex hormones, Dr. Dhaliwal adds.

People with chronic kidney and liver disease tend to have low body mass in general, poor nutrition, and may take steroids, all of which can exacerbate bone loss, says Dr. Dhaliwal. “If kidney disease is advanced enough, it itself causes a metabolic bone disorder similar to osteoporosis and can lead to fractures,” she adds.

In addition, anyone who receives an organ transplant is at a higher risk of bone density loss. That’s because transplant recipients typically take large doses of steroids to prevent organ rejection, and many people are very sick and immobile for a bit after the transplant, Dr. Moseley explains.

Neurological disorders

Multiple sclerosis, cerebral palsy, stroke, spinal cord injury, or any other neurological condition that leads to a decline in physical activity, mobility, and muscle mass, can increase a person’s risk of osteoporosis over time, Dr. Dhaliwal says.

Certain medications that people take for neurological disorders, specifically anti-seizure medications for epilepsy, can thin the bone in the long term, says Dr. Moseley. The impact is especially great if these meds are started at an early age and taken for decades.