Vitamin D

You need vitamin D to absorb Calcium. vitamin D is synthesized in the body when in direct
contact with sunlight, but can also be gotten from diet. Low levels of vitamin D can result in
high parathyroid hormone levels, which can increase bone loss.
Smoking
Increased risk of bone loss due to toxins which can affect bone in many ways, such as
exposing free radicals in the body, which attack bones and other organs. Toxins also upset the
balance of hormones, decreasing oestrogen and calcitonin while increasing cortisol, all things
that cause bone loss. Smoking also damages blood vessels, which leads to poor blood supply
of oxygen to bones, causing bone loss and slow healing processes in the event of a fracture.
Nerves in toes and feet can also be damaged, which leads to more falls and fractures.
Excessive Alcohol
May cause dietary and liver problems and low levels of sex hormones, which can affect bone.
Alcohol also impedes the ability of the stomach to absorb calcium adequately and the ability
of the pancreas to absorb calcium and vitamin D. Alcohol also affects the liver, which is
important for activating vitamin D.

Gastrectomy
May lead to a difficulty in absorption of nutrients, which could then place a person at risk.
Small bowel resection
May lead to a difficulty in absorption of nutrients, which could than place a person at risk.
Coeliac disease
Untreated coeliac disease can lead to complications such as cancer and osteoporosis. Due to
the problem with absorption, bone loss can occur. Even if you are getting enough calcium
through your diet, you may still be deficient. Please log on the Coeliac Society of Ireland's
website for further information http://www.coeliac.ie/
Crohns disease
The disease itself places a person at risk and the main treatment for it is steroid based, which
can affect bone.
Ulcerative Colitis
Due to the problem with absorption and treatment, bone loss can occur.
Haemochromatosis
Excessive iron is deposited in liver and other organs, which may result in low levels of sex
hormones, which can affect bone.
Liver disease
As the metabolism of sex hormones are affected, this may increase the risk of Osteoporosis.
Also affects the activation of vitamin D.
Primary Biliary Cirrhosis
Affects liver and hormones which can affect bone. Creates other factors that are associated
with an increased risk for osteoporosis, such as lower weight and shorter height.
Kidney disease
Can sometimes cause secondary Hyperparathyroidism, which can cause bone loss. Can also
cause abnormalities of calcium, vitamin D, bone turnover, mineralization, linear growth,
volume, or strength of bone.
Bone Marrow Disorders
Multiple Myeloma, Systemic Mastocytosis, Disseminated carcinomatosis, all may increase
bone loss.
Rheumatoid Arthritis
Steroids from treating rheumatoid arthritis and the inflammation from the disease itself can
affect bone.

Connective Tissue Disorders
May have abnormal bone collagen which can increase a persons risk.
Osteogenesis Imperfecta
A genetic abnormality which affects collagen in the bone, characterized by bones that break
easily, often from no apparent cause. All types of Osteogenesis Imperfecta have the tendency
to result in low bone density for patients at some point in their lives.
Marfan Syndrome
May have an increased risk due to abnormal collagen.
Metabolic Disorders
Such as Homocystinuria are extremely rare, due to an enzyme deficiency, which may affect
collagen metabolism, and therefore place a person at risk of developing Osteoporosis.
Ehlers-Danlos Syndrome
This is a rare skin disorder, that is usually treated with steroids which can affect bone.
Polymyalgia
It is a connective tissue disease, which results in pain in muscles and is often associated with
low levels of vitamin D. Steroids is one of the treatments for this disease which can affect
bone.
Systemic Lupus
Steroids are one of the treatments for this disease, which can affect bone. In addition, pain
and fatigue caused by the disease can result in inactivity, further increasing osteoporosis risk.
Some studies also show that bone loss in lupus may occur as a direct result of the disease.
Scoliosis
It is an abnormal curvature of the spine which may predispose a person and also can result in
reduced mobility.
Diabetes
Type 1 diabetes is linked to low bone density, although researchers dont know exactly why.
Insulin, which is deficient in type 1 diabetes, may promote bone growth and strength. The
onset of type 1 diabetes typically occurs at a young age when bone mass is still increasing. It
is possible that people with type 1 diabetes achieve lower peak bone mass. Those with poorly
controlled diabetes appear to be at a higher risk especially those with peripheral neuropathy.
Epilepsy
Anticonvulsants, the main treatment for epilepsy, may affect calcium absorption and the
circulating levels of vitamin D in the blood.
Cystic Fibrosis
Steroid treatment can affect bone.
Prolactin Raising drugs
High levels of prolactin results in reduced secretion of the sex hormones, oestrogen and
progesterone, which can affect bone.
Medications for Depression
Some medications for depression may increase the levels of prolactin in women and men,
which reduces secretion of the sex hormones, affecting bone.. This can result in menstrual
disturbances in women and loss of libido in men. Please check with your doctor.
Aromatase inhibitor
These are used in the treatment of cancer of the breast and cancer of the prostate, to decrease
sex hormones levels, however they can both affect bone.
GnRH analogues
Are sometimes used for the treatment of cancer of the prostate, cancer of the breast in
females and endometriosis in females. It decreases the sex hormones in males and females,
which could place them at risk.
Organ transplant
The treatments are usually immunosuppresants and steroids, both which affect bone.
Asthma
Treated with corticosteroids, which contributes to bone loss.
Human Immunodeficiency Virus (HIV)
Low bone mineral density is common in patients with HIV. While many risk factors, such as
smoking, weight loss, and poor nutrition can lead to low BMD, HIV infection itself is thought
to cause chronic inflammation, which can affect bones. Research shows that starting HIV
medications can be associated with reductions in bone density, especially in the first 2 years
of treatment.
Additional Risk Factors for Women
If your First period was after age 15
Late production of sex hormones which can affect bone.
A person going through the Menopause
Levels of oestrogen drop which can affect bone.
An early menopause (under 45 years)
Levels of oestrogen drop which can affect bone.
Surgical menopause, an ovary/ovaries removed, or hysterectomy
Oestrogen levels will drop which can cause bone loss.
Depot Provera
Contraceptive which affects bone and can increase risk of Osteoporosis, especially if taken
during the adolescent years, when bone is being formed.
Pre-menstrual tension
Is usually the result of low progesterone levels which may affect bone.
Irregular periods or loss of periods for more than 4 months - other than pregnancy
This can be a sign that your hormones may be out of balance.
Additional risk factors for Men
The Most common cause in Males is Testosterone Deficiency
Low levels of Testosterone = Hypogonadism
Hypogonadism
When a person experiences one or all of the following: loss of sex drive, loss of erections,
depression or fatigue
Testes removed
This may cause low levels of testosterone which may affect bone.
Mumps after puberty
This may cause low levels of testosterone which may affect bone.
Injury or infection of testes
This can cause low levels of testosterone which may affect bone.

The following medications/treatments may increase bone loss
Chemotherapy
Toxic affect on tissues, results in low hormone levels.
Radiation
Toxic affect on tissues, result in low hormone levels.
Thyroxine
Increases metabolism and bone loss.
Excessive Eltroxin
Increases metabolism and bone loss
Corticosteroids
For example Prednisolone, Prednisone, Cortisone, Delta Cortril can affect bone.
Aromatase inhibitors
Aromatase inhibitors decrease sex hormones in females with breast cancer, such as Arimedex
and GnRh analogues for prostate cancer in males, which affect bone.
Aluminum-containing antacids
FK506 (Tacrolimus)
Gonadotropin releasing hormone (GnRH)
Such as Zoladex
Medroxyprogesterone acetate for contraception
Depo-Provera
Proton pump inhibitors (PPIs)
Such as Nexium
Anticonvulsants
Some anticonvulsants decrease calcium absorption which will affect bone.
Post Organ Transplant Therapy
Toxic affect on tissues, may result in low hormone levels which affect bone.
Chronic Heparin
Increased bone loss due to activity of osteoclasts, which remove bone.
Warfarin
Increases bone loss.
Antipsychotic medications
Some increase prolactin levels in the blood, which affects bone.
Long Term Lithium Therapy
May increase bone loss.
Calciuretic Diuretics (water pills)
Some of these can affect bone.
If you are on any medication or have a condition that is not listed above, please check with
your doctor to see if it can put you at risk of developing osteoporosis.