Chronic Disease, Physical Activity and Osteoporosis

Several chronic diseases, both acquired and genetic are associated with increase loss of bone mass and risk of osteoporosis as a result, although the mechanism of bone loss and resultant osteoporosis are different in different diseases. But in general the bone loss has multiple factors such as nutrition, physical inactivity or reduced physical activity levels (due to chronic disease), and factors that affect bone-remodeling rates. In chronic disease the diagnosis of osteoporosis is commonly made before clinical symptoms of osteoporosis appears.

Physical activity and osteoporosis:

Physical activity (inactivity) is an important factor in etiology of osteoporosis. Prolonged physical inactivity due to paralysis or chronic disease (bed rest) results in significant bone loss. Physical activity is the reason of higher bone mass among athletes than the general population. Although for best effects, physical activity should be started before puberty (during time of growth and development), as children are more capable to add bone mass through physical activity, than adults. Regular physical activity if started in adult life has only modest effect on bone mass increase (only 1–2% in short-term).

Epidemiological studies suggests that risk of fracture is lower in rural communities (in compare to urban communities of same area) and in countries where physical activity is maintained into old age, although many experts argue that the risk of fracture is lower among physically active people as they are less likely to fall and are more capable of protecting themselves better upon falling.

If you are suffering from any of the flowing diseases, you are at higher risk of osteoporosis:

Nutritional and gastrointestinal disorders:

  • Malnutrition, gastrectomy (surgical removal of stomach), mal-absorption syndromes, parenteral nutrition, pernicious anemia, liver disease (billiary cirrhosis) etc.

Hormonal disorders:

  • Cushing’s syndrome, thyrotoxicosis, hyperparathyroidism, type-1 diabetes, adrenal insufficiency, hypothalamic amenorrhea, hyperprolactinemia, acromegaly.

Genetic disorders:

  • Turner syndrome, Klinefelter syndrome, Thalassemia, Marfan syndrome, porphyria, hemochromatosis, osteogenesis imperfecta, glycogen storage diseases, homocystinuria, hypophosphatasia, Ehlers-Danlos syndrome etc.

Rheumatologic/ Hematologic disorders:

  • Rheumatoid arthritis, ankylosing spondylitis, multiple myeloma, lymphoma, leukemia, Hemophilia etc.

Miscellaneous chronic diseases associated with osteoporosis:

  • Prolonged bed rest (Immobilization due to multiple fractures), pregnancy and lactation, anorexia nervosa, COPD (chronic obstructive pulmonary disease), scoliosis, sarcoidosis, amyloidosis, multiple sclerosis, chronic smoking etc.

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