IBS and Osteoporosis Risk

woman drinking milk
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Did you know that doctors now ask you if you have irritable bowel syndrome (IBS) when you go for a bone density test for osteoporosis? This is because IBS is now seen as a risk factor. In this overview, we will discuss why this is so and what you can do to reduce your risk.

What Is Osteoporosis?

Osteoporosis is a health condition in which a person's bones have become reduced in mass and the process of forming new bone becomes impaired.

This results in bones that are more fragile and therefore at greater risk for experiencing bone fractures. Such fractures are most likely to occur in the hips, vertebrae, and wrists, and are not necessarily caused by a significant impact. These fractures can lead to other health problems and a higher risk for premature death.

Risk Factors for Osteoporosis

Osteoporosis can be the result of normal aging, particularly in post-menopausal women. Some health problems and some medications can contribute to the problem. The following are factors that have been identified as increasing one's risk for osteoporosis:

  • Being female, particularly if you are Asian or Caucasian
  • Getting older
  • Use of steroid medications
  • Having a low body mass index (BMI)
  • Being a cigarette smoker
  • Excessive use of alcohol
  • Having a relative who has osteoporosis
  • Low intake or absorption of vitamin D and calcium

Certain health problems also raise your risk for osteoporosis:

  • High blood pressure
  • Osteopenia
  • Type II diabetes
  • Parkinson's disease

Gastrointestinal Disease as a Risk Factor

The following gastrointestinal diseases have been associated with a higher risk of having osteoporosis and of experiencing a fracture because of it:

Celiac DiseaseThe increased risk of osteoporosis and related fractures in celiac disease has been thought to be the result of vitamin deficiencies, (particularly calcium and vitamins D and K), that result when the villi of the small intestine are damaged from eating foods containing gluten.

Following a gluten-free diet can reverse the trend and reduce one's risk.

Inflammatory Bowel Disease: These higher risks of osteoporosis and related fractures are seen in both Crohns disease and ulcerative colitis. Although steroid use has been thought to be a primary reason behind this increased risk, some researchers think that the increased risk is as a result of the inflammatory process inherent in the disease.

IBS and Osteoporosis Risk

The higher risk of osteoporosis in people who have celiac disease or IBD is has prompted researchers to take a look to see if having IBS might raise one's risk for osteoporosis as well.

One large-scale study looked at a series of IBS patients who experienced an emergency room visit. These patients had a higher risk of having a diagnosis of osteoporosis and to experience an osteoporosis-related fracture of the hip, vertebrae or wrist, than emergency room patients who did not have IBS.

Another large scale study located in Taiwan found higher rates of osteoporosis in individuals who had IBS compared to those who did not have the disorder.

Female patients, ages 40 to 59, were at highest risk for osteoporosis.

One smaller study looked at osteoporosis risk in patients diagnosed with IBS versus those diagnosed with "non-celiac wheat sensitivity" (NCWS). (The researchers differentiate this from non-celiac gluten sensitivity as they posit that it is unclear which components of wheat are causing unwanted digestive and other symptoms.)

Keeping in mind that this was a small study and therefore no firm conclusions can be drawn, the results are interesting. The researchers found that the NCWS patients had significantly lower bone mass measurements than those who had IBS. What is disturbing about this finding is that study patients were mostly younger and pre-menopausal women. The researchers posit that this lessening of bone mass may be the result of malnutrition due to self-imposed dietary restrictions. They support this supposition by the finding that NCWS patients had lower calcium intakes than IBS patients and the additional finding that NCWS patients who had multiple food sensitivities had a greater loss of bone mass than the other patients in the study.

Why the Increased Risk?

As of now, the reasons behind the increased risk of osteoporosis in people who have IBS remain murky. The researchers behind the emergency room study float three possible theories:

1. Altered serotonin levels: Serotonin is a neurotransmitter that is found throughout the digestive system. It has been found to play a role in bone density and is thought to play a possible role in contributing to IBS symptoms.

2. Low intake of calcium: It is possible that the increased risk of osteoporosis is related to the fact that many people who have IBS avoid dairy products, due to a perceived lactose intolerance or because they are following the low-FODMAP diet for IBS.

3. Inflammation: Although by definition, there is no visible sign of intestinal inflammation in IBS, researchers are finding that IBS patients may have higher levels of cytokines - substances associated with inflammation. Cytokines are thought to play a role in decreased bone mass density.

How to Minimize Your Risk for Osteoporosis

The classic recommendations for reducing your risk of osteoporosis are related to exercise and nutrition. Let's translate these recommendations to account for your IBS...

Exercise Regularly: The exercises that are thought to encourage bone growth are those that are weight bearing and those that involve resistance. Weight bearing exercises include walking, running, dancing and vigorous sports. If your IBS keeps you close to home for bathroom access, you can still choose to walk on a treadmill, or follow a dance or aerobic exercise video. Resistance exercises include using free weights, weight machines, resistance bands, and yoga, all of which can be done at home.

Make sure your vitamin D levels are adequate: Ask your doctor to test to make sure that you are taking in enough vitamin D, which is essential for bone strength. You can get vitamin D through sunlight exposure and supplements.

Make sure you are taking in enough calcium: Your best source for calcium is through the foods that you eat. Green leafy vegetables, such as bok choy, collard greens, and kale, are good calcium sources that are also IBS-friendly. If you are avoiding dairy products due to your IBS, you may find that you can tolerate lactose-free milk and low-FODMAP cheeses, such as cheddar and mozzarella. There are some questions about possible health risks, as well as questions about the benefits, of taking a calcium supplement. Do your research and discuss the issue with your doctor.

Things to avoid:

  • Watch your salt intake as too much sodium can cause you to excrete too much calcium through your urine
  • Avoid excessive alcohol use.
  • Don't smoke.

Sources:

"Calcium" National Institutes of Health Office of Dietary Supplements Website accessed April 5, 2016.

Carroccio, A., et. al. "Risk of low bone mineral density and low body mass index in patients with non-celiac wheat-sensitivity: a prospective observation study" BMC Medicine 2014 12:230.

Franco, C. "Osteoporosis in gastrointestinal diseases" Translational Gastrointestinal Cancer 2015 4:1.

"Once Is Enough: A Guide to Preventing Future Fractures" NIH Osteoporosis and Related Bone Diseases National Resource Center Website accessed April 4, 2016.

Stobaugh, D., Deepak, P. & Ehrenpreis, E. "Increased risk of osteoporosis-related fractures in patients with irritable bowel syndrome" Osteoporos International 2013 24:1169-1175.

Yen, C., et. al. "A nationwide population cohort study: Irritable bowel syndrome is a risk factor of osteoporosis" European Journal of Internal Medicine 2014 25:87-91.

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