Medical conditions affecting nutrition and bone health
Anorexia nervosa
Anorexia nervosa is a psychophysiological disorder, usually occurring in young women, that is characterized in part by a persistent unwillingness to eat and severe weight loss. The disorder usually begins during adolescence - the time of life when good nutrition is important in order to gain the highest possible peak bone mass. Besides depriving the body of essential bone-building nutrients, an anorexic patient's extreme thinness also results in estrogen deficiency and amenorrhea (cessation of menstruation). People with anorexia are therefore at high risk of developing osteoporosis, and must be counseled accordingly.
Glucocorticoids
Glucocorticoids are steroid hormone medications including cortisone, prednisone and dexamethasone, and they are used to treat chronic inflammatory diseases such as rheumatoid arthritis, asthma, Crohn's disease, and some skin and liver diseases. They are known to cause substantial bone loss early in the course of treatment and can also interfere with calcium metabolism, and are therefore an important risk factor for osteoporosis. Patients taking glucocorticoids long-term (more than three months) should be assessed for osteoporosis risk and counseled on preventive lifestyle factors including ensuring sufficient calcium and vitamin D intake (probably with supplements) and weight-bearing exercise.
Inflammatory bowel disease
Patients with inflammatory bowel diseases such as Crohn's disease or ulcerative colitis are at increased risk of bone loss due to a variety of factors including poor food intake and nutritional status, poor absorption of nutrients (including calcium, vitamin D and protein), and surgery to remove parts of the intestine. Osteoporosis prevention measures that ensure adequate calcium and vitamin D through food or supplements must be part of the overall care strategy for these patients. Osteoporosis medications may also be advisable, as determined by a doctor.
Celiac disease
Celiac disease is a genetically mediated autoimmune disease characterized by intolerance to gluten found in wheat, rye and barley. People affected suffer damage to the intestinal surface, which results in inadequate nutrient absorption, and symptoms such as diarrhea and weight loss. Poor absorption of nutrients including calcium and vitamin D places sufferers at increased risk of osteoporosis. The disorder must be controlled by strictly following a gluten-free diet, which allows the intestinal surface to heal and for nutrients to be properly absorbed again.
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