Gastrointestinal (GI Disease)

Why do some gastrointestinal diseases increase the risk for osteoporosis?

Studies have found an increased risk of bone loss and fractures (broken bones) in individuals with certain gastrointestinal (GI) diseases. People with GI diseases may be at increased risk for osteoporosis for many of the following reasons.

  • The inflammatory process- Natural chemicals in the body that are related to intestinal inflammation in inflammatory bowel disease and probably also in celiac disease are known to increase bone breakdown.
  • Malnutrition- Malabsorption of vitamin D, calcium, magnesium, possibly vitamin K, and other nutrients may contribute to bone loss in patients with GI disease.Excessive thinness is also considered an important risk factor for hip fracture.
  • Weight loss- Loss of weight that may occur as a result of many GI diseases can be an important factor in reducing bone mass. Excessive thinness is also considered an important risk factor for hip fracture.
  • Longterm use of certain medications that can cause bone loss – Steroid medications (such as cortisone or prednisone) taken for more than three months may be prescribed and necessary to treat GI diseases.
  • Lifestyle factors- Sometimes chronic GI conditions and or the medications used to treat the conditions may increase fatigue and the likelihood of inactivity. A sedentary lifestyle increases the risk for bone loss. In all populations, smoking increases the risk for osteoporosis and related fractures.

What gastrointestinal conditions increase the risk of low bone mineral density?

A low bone mineral density compared to the general population has been reported among patients with certain GI conditions:

  • removal of the stomach (gastrectomy) and bariatric surgery
  • celiac disease
  • Crohn’s disease
  • ulcerative colitis

The likelihood of bone loss is potentially greater among older adults with the above GI conditions. In some older adults with GI disease, age-related bone loss along with low bone mineral density compared to the general population, may lead to osteoporosis.

How can I reduce my risk for broken bones if I have GI disease?

  • The treatment of your intestinal disorder is the most important step to prevent bone loss and osteoporosis. Consult with your healthcare provider to find out the best way to manage your GI disease.The treatment of your intestinal disorder is the most important step to prevent bone loss and osteoporosis. Consult with your healthcare provider to find out the best way to manage your GI disease.
  • If you take chronic steroid medications, it is important to speak to your healthcare provider about how to best manage your gastrointestinal disease and at the same time be on the lowest possible dose of steroid medication for the shortest period of time possible.Men or women who are planning to use, currently use, or have a history of using long-term steroid medications (for more than 3 months)
  • It  is important to identify people at the highest risk for fracture. The best predictors for fracture among individuals with GI diseases include active inflammatory bowel disease,  long-term use of steroid medications, history of a previous osteoporosis-related fracture, low bone density, and an increased risk for falling.
  • A bone mineral density (BMD) test using dual x-ray absorptiometry (DXA) is used by healthcare providers to diagnose osteoporosis before a fracture occurs, determine the need for osteoporosis treatment, and help monitor the response to osteoporosis medications. It is important to speak to your healthcare provider to find out when the right time is for you to have a BMD test.
  • If your bone mass is sufficiently low or if you have a history of fracture, speak to your healthcare provider to find out if an FDA-approved medication for osteoporosis is right for you. If you are prescribed an osteoporosis medication it is important to consume the recommended amount of calcium and vitamin D in order for your medications to work properly.

How can I protect my bones if I have GI disease?

There are some very simple steps to take to help promote stronger bones:

Eat a variety of healthy (nutrient-rich) foods taking any special dietary restrictions into consideration.

Reach and maintain a healthy weight. Eat the amount of calories and protein you need. The amount that you need will depend on your height, weight, age, and medical condition.

Get the calcium you need. It is recommended that healthy adults consume 1000 to 1200 milligrams (mg) of calcium each day. If you have a medical condition that interferes with the way your body uses calcium, your healthcare provider may recommend slightly more. It is best to get calcium from the foods you eat. It is important to only eat the calcium rich foods you tolerate and/or those that are permitted if you are on a special diet. Foods rich in calcium such as low fat dairy foods (milk, yogurt, cheese), dark green leafy vegetables (bok choy, broccoli, collard greens, kale, mustard greens, and turnip greens), canned fish (sardines, salmon) eaten with bones, or calcium-fortified (with calcium added) foods. The body best uses calcCalcium is used best by the body when it is spaced out through the day. Try to eat a calcium rich food that you can tolerate at each meal. If you think that you are not getting the recommended amount of calcium in the foods you eat, it is important to consult with your healthcare provider to find out if a calcium supplement is right for you. Do not take a calcium supplement without the advice of your healthcare provider. Consuming too much calcium may be harmful.

Get the recommended amount of vitamin D. It is important to eat only the vitamin D foods you tolerate and/or those that are permitted if you are on a special diet. There are only a few good natural sources of vitamin D including fatty fish such as catfish, eel, mackerel, salmon, sardines, tuna and shiitake mushrooms. Small amounts of vitamin D are added to all cow’s milk, some types of beverages (almond, coconut, rice, or soy beverages and orange juice), yogurt, cheese, and nutrition bars. Adults 50 years of age and above should consume 800-1000 IU or 20-25mcg daily. Your healthcare provider may recommend more vitamin D than above stated amounts based on your individual needs.

Be physically active. Your bones get stronger and denser when you make them work. Walking, climbing stairs, and dancing are impact (or weight-bearing) exercises that strengthen your bones by moving your body against gravity when you are standing. Resistance exercises such as lifting weights or using exercise bands strengthens your bones and your muscles too! Tai Chi is an example of physical activity that improves posture and balance to help decrease the risk for falls and fractures. Exercise can be easy; try 10 minutes at a time, adding the minutes up to reach your goal.

Don’t smoke. If you do, STOP. Call 1-800-NYQUITS for information about how to quit.

Limit alcohol. Before drinking alcohol, it is important to speak to your healthcare provider about possible interactions with your medication or your medical condition. Too much alcohol can be harmful for your bones and your overall health.

Take action to prevent falls. Most broken bones occur as a result of a fall that can be prevented. Some actions to prevent falls at home include using nightlights, removing or securing scatter rugs, and getting rid of clutter.