Hormonal/Endocrine Disorders

What do the terms “endocrine” and “hormone” mean?

The endocrine glands of the body include the pituitary, thyroid, parathyroid, adrenal, pineal, and thymus glands. The pancreas, ovaries, and testes also act as endocrine glands. The endocrine system is a controlling system of the body. It controls cell activities by releasing chemical messengers called hormones into the bloodstream.

What are estrogen and testosterone?

Estrogens and testosterone are important hormones and are both normally present in females and males. In females, estrogen works together with other hormones such as progesterone and testosterone to control puberty, monthly periods, healthy reproduction, and bone health. Estrogen, produced mainly by the ovaries in females, is necessary for the growth (in girls and young women) and the maintenance (in adulthood) of normal healthy bone.

In males, testosterone is the main male sex hormone produced mostly by the testes. Testosterone is responsible for normal development of sex organs, puberty, and fertility in males. For males, normal testosterone and estrogen levels are necessary for the growth and maintenance of muscle and bone mass.

What is the role of hormonal balance in the promotion of healthy bones in youth?

Peak bone mass, defined as the maximum bone density an individual will ever have, is reached by 25 years of age. Hormonal balance is one of the factors necessary to reach peak bone mass. Low levels of hormones (estrogen and/or testosterone) during youth and young adulthood are associated with lower peak bone mass.

What is the role of hormonal balance in the promotion of healthy bones in adulthood?

In adulthood, after peak bone mass is reached, low estrogen levels in women can increase the rate of bone breakdown and cause bone loss. In men, any condition or disease causing low levels of testosterone or estrogen may also result in bone loss.

When you have a hormonal or an endocrine disorder it is crucial to consult with your healthcare provider to get the medical treatment necessary to control your condition and optimize your bone health.

The following conditions associated with endocrine/hormonal disorders (listed alphabetically) may increase the risk for osteoporosis:

Amennorhea
Cushing’s Disease
Diabetes Mellitus
Eating Disorders
Hyperparathyroidism
Hyperprolactinemia
Kleinefelter Syndrome
Thyroid Disease
Turner Syndrome

AMENNORHEA

What is amennorhea?

Amenorrhea is the absence of menstrual cycles. It is normal to have amenorrhea during pregnancy and while using certain medications prescribed by healthcare providers during premenopausal stage of life. However, there are a number of medical conditions that can also cause amenorrhea in premenopausal women. For example, the athletic female triad is a syndrome consisting of disordered eating, excessive exercise, and amenorrhea that results in bone loss. Bone density is lower in athletes with amenorrhea in comparison to athletes with regular menstrual cycles. Some of the other common causes of amenorrhea include the use of certain medications in medical conditions such as thyroid disease, polycystic ovarian syndrome, and pituitary disorders.

How does amennorhea affect bone health?

Amenorrhea that is not related to pregnancy can often lead to lower bone density, particularly if it is related to lower estrogen levels. In all cases, it is important to consult with a doctor or healthcare provider to determine the cause for amenorrhea. Early detection and treatment of disorders causing amenorrhea may help reduce the risk for osteoporosis.

CUSHING’S DISEASE

What is Cushing’s disease?

Cushing’s disease is caused by the presence of a non-cancerous (benign) tumor on the pituitary gland. In this condition, the body produces an excess of cortisol, a steroid hormone.

How does Cushing’s syndrome affect bone health?

This overproduction of cortisol can produce the same problems for bones as that caused by the use of steroid medications.

DIABETES MELLITUS

What is diabetes?

Diabetes is a condition characterized by high blood glucose levels resulting from the body’s inability to use blood glucose for energy. In Type I diabetes, the pancreas no longer makes insulin and therefore blood glucose cannot enter the cells to be used for energy. In Type II diabetes, either the pancreas does not make enough insulin or the body is not able to use insulin properly.

How does Type 1 diabetes affect bone health?

Type I diabetes appears to be a significant risk factor for osteoporosis. In Type I diabetics, the cells that form bone do not seem to work as well as those in the non-diabetics, perhaps due to absence of the bone forming effects of insulin. This may be one of the reasons why low bone mass occurs. Further research is needed to better understand the complex relationship between Type I diabetes and osteoporosis.

How does Type II diabetes affect bone health?

People with Type II diabetes usually have normal or even increased bone mass compared with those without diabetics. The higher body weight typical of individuals with Type II diabetes may account for normal or increased bone mass. However, evidence suggests that despite normal bone mass, people with Type II diabetes tend to have a higher risk for fracture than non-diabetics. Much of the increased risk for fracture is due to a higher risk for falls. To begin with, many women with Type II diabetes are overweight and inactive. These two factors tend to lessen coordination and balance making it more likely for a person to fall. People with Type II diabetes often have complications such as impaired vision, peripheral nerve damage, or foot problems, all of which can contribute to a fall. Finally, some people with Type II diabetes (especially if their blood glucose is poorly controlled) find that they frequently have to get out of bed during the night to use the bathroom. Walking around in the dark in a sleepy state, especially without proper lighting, can greatly increase the risk of falls.

How can people with Type I and Type II diabetes protect their bones?

There are many actions that individuals with diabetes can take to help protect their bones:

• It has been observed that bone loss is greater in people with poorly controlled diabetes as compared to those with blood glucose levels under control. Therefore, keeping blood glucose levels close to normal is the first line of defense against osteoporosis, falls, and fractures.
• It is important for all people with diabetes to achieve and maintain a stable, ideal body weight.
• People with diabetes are advised to get the recommended amounts of vitamin D  and calcium.
• Physical activity is another important defense. It reduces bone loss, improves muscle strength and balance, and helps prevent falls.
• Other important strategies for strong bones include avoidance of smoking and limited consumption of alcoholic beverages.
• All individuals with diabetes should have routine visual assessment.
• It is of utmost importance to implement strategies for fall prevention. For example, some well-placed night lights can greatly help reduce the risk for falls during the night. If a patient is at increased risk for falling, it is important to speak to your healthcare provider about getting a referral to a physical therapist for a comprehensive falls evaluation and gait-training program.
• Postmenopausal women and men over age 50 with Type I or Type II diabetes should speak to their healthcare provider about when to get a bone mineral density (BMD) test.

HYPERPARATHYROIDISM

What are the parathyroid glands and what do they do?

The parathyroid glands are four small endocrine glands (the size of peas) that are located at the base of the neck next to the thyroid gland. Although they are neighbors and both part of the endocrine system, the thyroid and parathyroid glands are otherwise not related. The parathyroid glands produce parathyroid hormone that is largely responsible for maintaining normal levels of calcium in the blood.

What is hyperparathyroidism?

Hyperparathyroidism is overactivity of one or more of the parathyroid glands. In hyperparathyroidism, too much parathyroid hormone is produced. In primary hyperparathyroidism, excessive levels may be the result of a tumor (that is usually benign). A surgical procedure to remove the benign tumor is often required.

How does hyperparathyroidism affect bone health?

Hyperparathyroidism can result in bone loss and higher calcium levels in the blood. Primary hyperparathyroidism may lead to a lower bone mass at some skeletal sites while bone mass at other skeletal sites will be preserved. A recent study found that there was an increased risk for fractures (broken bones) at the spine, forearm, and lower extremities in people with primary hyperparathyroidism. The increased fracture risk can occur several years before undergoing surgery to remove the parathyroid gland. After parathyroid surgery, fracture risk stabilizes and there is no additional fracture risk associated with the disease.

HYPERPROLACTINEMIA

What is hyperprolactinemia?

Hyperprolactinemia is a condition characterized by an overproduction of prolactin, the hormone responsible for milk production in a woman’s breasts. Often women with hyperprolactinemia experience a milky discharge from their breasts and amennorhea, the stopping of their menstrual periods.

How does hyperprolactinemia affect bone health?

Increased prolactin levels can lead to decreased bone density when compared with healthy individuals of the same age. It is important to consult a healthcare provider  to diagnose and treat hyperprolactinemia. Treatment with certain medications typically results in the return of normal ovarian function and lowers the risk for osteoporosis.

KLINEFELTER SYNDROME

What is Klinefelter syndrome?

Kleinfelter syndrome is the most common sex chromosome variation in males. It is estimated to occur in 1 out of 500 men. The disease is caused by an extra X, or female, sex chromosome. The extra X chromosome interferes with the development of male characteristics. Men with Klinefelter syndrome often have low testosterone levels. Characteristics of Klinefelter syndrome vary from person to person.

How does Klinefelter Syndrome increase the risk of Osteoporosis?

The low testosterone levels associated with Klinefelter syndrome increase the risk for developing osteoporosis. The lower the testosterone level, the lower the bone density.

THYROID DISEASE

What is thyroid hormone?

Thyroid hormone is released  into the bloodstream by the thyroid gland located in the front of the neck. The purpose of thyroid hormone is to regulate the body’s metabolism. It can affect heart rate, body weight, energy level, muscle strength, skin condition, mental state, intestinal function, bone health, and menstrual cycles in females.

How does thyroid disease affect bone health?

Excessive thyroid hormone can increase bone loss and hence, the risk of developing Osteoporosis.

Conditions resulting in increased thyroid hormone levels:

• Hyperthyroidism – Bone loss can happen when there is an excess of thyroid hormone, a condition called overactive thyroid disease, hyperthyroidism, or Graves’ disease.

• Hypothyroidism treated with excess thyroid medication– Hypothyroidism is a condition in which there is too little thyroid hormone. People with hypothyroidism commonly take thyroid medication to replace what their own glands are not making. Loss of bone occurs in people with hypothyroidism who take more than the needed amount of thyroid medication. In contrast, taking the correct amount of thyroid medication will not produce any adverse effects on bone.

• Thyroid Cancer -Some people are treated with high doses of thyroid medication to stop the growth of small benign tumors called nodules. It is important to have nodules checked and the dose of medication routinely assessed by a healthcare provider. In rare cases of thyroid cancer, large doses of thyroid medication may be necessary to prevent stimulation of the thyroid tissue. High doses of thyroid medication increase the risk for bone loss and osteoporosis. It is important to follow the advice of your healthcare provider in order to get treatment for your condition.

How can people with thyroid disease protect their bones?

• Assess your risk for osteoporosis: The skeletal effects of thyroid disease vary based on gender, menopausal status, and other risk factors for osteoporosis. By using the appropriate NYSOPEP risk assessment tool, you can find out more about your personal risk factors for osteoporosis.

• Get a BMD (bone mineral density) test when appropriate: Women who have conditions associated with excess thyroid hormone should get a bone density test as early as possible after menopause. It is important for men over age 50 with thyroid disease to consult with their healthcare provider to find out the appropriate time for a BMD test.

• Ask your healthcare provider about a routine TSH blood test– It is important to speak to your healthcare provider about the effects of thyroid medication on bone and about the strategies to optimize bone health. Anyone on thyroid medication should be sure to see their healthcare provider regularly and get a routine blood test (called a TSH level) as often as prescribed. This is necessary to make sure that the dose of thyroid medication is correct. It is important to take thyroid medication as instructed by your treating healthcare provider and not to change or stop taking it even if you feel better, without talking to your healthcare provider first.

TURNER SYNDROME

What is Turner syndrome?

Turner syndrome is a chromosomal condition that only affects girls and women. It occurs when one of the two X chromosomes normally found in females is missing or incomplete. Almost all people with Turner syndrome have short stature and loss of ovarian function resulting in low estrogen levels. No real causes have been found for this condition. It appears to randomly occur and affects 1 out of 2500 female live births worldwide.

How does Turner Syndrome affect bone health?

There is a high incidence of osteoporosis in women with Turner syndrome. The main cause of osteoporosis appears to be low levels of estrogen but there may also be defects in bone structure and strength. Children with Turner syndrome do not tend to experience the increase in bone mass at puberty. Women with Turner syndrome tend to have lower bone mass than their peers.