Submitted by Elizabeth Madlem, APN, The Bone Health Clinic at Millennium Pain Center
Asthma is a chronic lung disease that affects more than 25 million Americans, nearly 7 million of whom are children. For people with asthma, everyday things can trigger an attack. These triggers include air pollution, allergens, exercise, infections, emotional upset, or certain foods. Typical asthma symptoms include coughing, wheezing, tightness in the chest, difficulty breathing, rapid heart rate, and sweating.
Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis often result in pain and disability. Osteoporosis has been called a childhood disease with consequences in old age because building healthy bones in youth can help prevent the disease later in life. In the United States, more than 53 million people either already have osteoporosis or are at high risk due to low bone mass. It is known as a “silent disease” because, if undetected, it can progress for many years without symptoms until a fracture occurs.
Asthma itself does not pose a threat to bone health. However, certain medications used to treat asthma and some behaviors triggered by concern over the disease, such as avoiding dairy products and lack of exercise, can have a negative impact on the skeleton. People with asthma tend to be at increased risk for osteoporosis, especially in the spine. Anti-inflammatory medications, known as glucocorticoids, are commonly prescribed for asthma. When taken by mouth, these medications can decrease calcium absorbed from food, increase calcium lost from the kidneys, decrease bone formation, and increase bone loss. Corticosteroids also interfere with the production of sex hormones in both women and men, which can contribute to bone loss, and they can cause muscle weakness, which can increase the risk of falling and related fractures. Even inhaled forms of corticosteroids can negatively impact bone health.
Strategies to prevent and treat osteoporosis in people with asthma are not significantly different from those used to treat people who do not have asthma.
A diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. Although many people are able to obtain enough vitamin D naturally, older individuals are often deficient in this vitamin due, in part, to limited time spent outdoors. Supplements can help you meet the daily requirements of calcium and Vitamin D, but this should be discussed with your health care provider.
People with asthma may think that milk and other dairy products trigger asthma attacks, although the evidence shows that this is only likely to be true if they also have a dairy allergy. This unnecessary avoidance of calcium-rich dairy products can be especially damaging for children with asthma who need calcium to build strong bones.
Like muscle, bone is living tissue that responds to exercise by becoming stronger. Because exercise often can trigger an asthma attack, many people with asthma avoid weight bearing physical activities, which are best for strengthening bone. Those people who remain physically active often choose swimming as their first exercise of choice because it is less likely than other activities to trigger an asthma attack. Unfortunately, swimming does not have the same beneficial impact on bone health as weight-bearing exercises, which work the body against gravity. Some examples of weight-bearing exercise include walking, jogging, racquet sports, basketball, volleyball, aerobics, dancing, and weight training. Regular exercise also enhances balance and flexibility, so the likelihood of falling and breaking a bone is reduced. People who experience exercise-induced asthma should exercise in an environmentally controlled facility and participate in activities that fall within their limitations.
Smoking is bad for bones as well as for the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol can also negatively affect bone health. Heavy drinkers are more prone to bone loss and fracture because of poor nutrition as well as an increased risk of falling. Reducing exposure to asthma triggers, such as irritants and allergens, can help lessen a person’s reliance on glucocorticoid medication. Avoiding people with colds and other respiratory infections and minimizing emotional stress can also be important
Like asthma, osteoporosis is a disease with no cure. However, there are many medications available to prevent and treat osteoporosis. Because of their effectiveness in controlling asthma with fewer side effects, inhaled glucocorticoids are preferred to oral forms of the medication. Bone loss tends to increase with increased glucocorticoid doses and prolonged use; therefore, the lowest possible dose for the shortest period of time that controls asthma symptoms is recommended.
It’s important for everyone to take control of their health — and this includes bone health. If you or your child is diagnosed with asthma, it’s important to be aware of the asthma-osteoporosis connection. If you have been diagnosed with osteoporosis or have many risk factors for developing the disease, a comprehensive osteoporosis treatment program that includes a focus on lifestyle changes, can be very beneficial in helping you to improve your health.
For more information on osteoporosis, you may contact The Bone Health Clinic at Millennium Pain Center, 309-662-4321. They have a new location at 2406 East Empire St. in Bloomington, next to Orthopedic & Sports Enhancement Center. Elizabeth Madlem is a certified bone health consultant. The clinic provides screening, diagnosis, and a comprehensive treatment plan for people who have or are at risk of developing osteoporosis.
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