Osteoporosis, alcohol

Clinical stresses which interfere with vitamin metabohsm, can result in calcium deficiency leading to osteomalacia and osteoporosis (secondary vitamin D deficiency). These stresses include intestinal malabsorption (lack of bile salts) stomach bypass surgery obstmctive jaundice alcoholism Hver or kidney failure decreasing hydroxylation of vitamin to active forms inborn error of metabohsm and use of anticonverdiants that may lead to increased requirement. 

Approximately one-third to one-half of osteoporosis cases in men and half of all cases in perimenopausal women are due to secondary causes.4 Common secondary causes in men include hypogonadism, glucocorticoid use, and alcoholism. The most common cause of drug-induced osteoporosis is glucocorticoid use. 

Some osteoporosis risk factors (see Table 53-1) are non-modifiable, including family history, age, ethnicity, sex, and concomitant disease states. However, certain risk factors for bone loss may be minimized or prevented by early intervention, including smoking, low calcium intake, poor nutrition, inactivity, heavy alcohol use, and vitamin D deficiency. 

Mineral deficiencies are not uncommon and can have quite a variety of causes—e. g., an unbalanced diet, resorption disturbances, and diseases. Calcium deficiency can lead to rickets, osteoporosis, and other disturbances. Chloride deficiency is observed as a result of severe Cr losses due to vomiting. Due to the low content of iodine in food in many regions of central Europe, iodine deficiency is widespread there and can lead to goiter. Magnesium deficiency can be caused by digestive disorders or an unbalanced diet—e.g., in alcoholism. Trace element deficiencies often result in a disturbed blood picture—i. e., forms of anemia. 

E. There is no good evidence that moderate amounts of alcohol contribute to osteoporosis. All... 

Dietary choices, sedentary occupations and lack of exercise are responsible for obesity and associated conditions including cardiovascular diseases and diabetes. Smoking, excessive alcohol intake and improper drug use curtail both life and its quality. As life expectancy increases it is mirrored by the increase in degenerative diseases such as arthritis, osteoporosis, cardiovascular disease, cancer, hearing and eyesight decline, and brain cell deterioration (Alzheimer s). 

First, Mrs TY is elderly and female which increases her risk of osteoporosis. She is postmenopausal. She drinks a small amount of alcohol but this is within the recommended weekly limits and is unlikely to cause a problem. She lives alone and therefore it is possible that her nutritional intake could be improved but this would need to be investigated further. 

Osteoporosis is also common in those on long-term corticosteroid therapy (for example patients with autoimmune hepatitis or coexisting inflammatory bowel disease). Patients with chronic liver disease may also have other risk factors for osteoporosis related to their disease state. These include vitamin D deficiency, excessive alcohol consumption, poor diet, physical inactivity and low body mass index. Oestrogen deficiency in the postmenopausal stage further increases the risk. 

Alcohol and some drugs can also affect calcium levels in the body, thus producing osteoporosis. Some of these drugs include thyroid medications, steroid preparations, anti-seizure medications, and certain chemotherapy (anti-cancer) agents. 

Osteoporosis is of two forms- primary i.e. idiopathic and secondary. Primary osteoporosis is classified into type I and type II osteoporosis. Type I is referred to post menopausal osteoporosis which is the main type affecting women, characterized by rapid bone loss and affects women after the menopause, mainly in trabecular bone and is associated with vertebrae and distal radio fractures whereas type II also termed as senile osteoporosis occurs due to chronic deficiency of calcium, increase in parathormone activity and decrease in bone formation and is associated with aging. On the other hand secondary type results from inflammatory processes, endocrine changes, multiple myeloma, sedentariness and the use of drugs such as heparin, corticoid and alcohol [3]. Prevention is the main treatment of osteoporosis, for which bone mass peak and the prevention of postmenopausal reabsorption are critical elements. The common treatment of osteoporosis includes calcium consumption as calcium salts, vitamin D supplements, and hormone reposition [4], the use of calcitonin to modulate serum levels of calcium and phosphorous [5], the use of bisphosphonate, mainly alendronates [6], use of ipriflavone and sodium fluoride [7], besides physical activity to strengthen muscles, stimulate osteoblasts formation and prevent reabsorption. 

The bone collagen cross-link (+)-deoxypyrrololine has potential clinical utility in the diagnosis of osteoporosis and other metabolic bone diseases. Intrigued by its novel structure and its promise to allow the early discovery of various bone diseases, the research team of M. Adamczyk developed a convergent total synthesis for this 1,3,4-trisubstituted pyrrole amino acid. The key step of the synthesis was the union of the nitroalkane and aldehyde fragments to obtain a diastereomeric mixture of the expected -nitro alcohol in good yield. This new functionality served as a handle to install the pyrrole ring. 

Postmenopausal women are vulnerable to osteoporosis, which largely involves trabecular bones including the spinal vertebrae. Estrogen deficiency plays a major role since estrogen replacement reduces the rate of bone loss. The mechanism for this effect has not been fully characterized but decreased estrogen resulted in increased IL-1 secretion from blood monocytes. IL-1 stimulates osteoclastic activity and bone resorption. Other risk factors include excessive alcohol consumption and smoking. 

Patient assessment should begin with identifying risk factors for osteoporosis and fractures (see Table 88-1). Important points include age, history of nontraumatic adult fractures, family history of osteoporosis or fragility fractures, comorbid medical and mental illnesses, lifestyle habits (diet, physical activity, smoking, and alcohol use), menstrual history, fall risk, prior and current medications (especially... 

Some men with osteoporosis possess clearly identifiable risk factors. In others, further investigation for secondary canses is warranted (see above patient assessment section). Men 70 years and older should have DXA tests to screen for osteoporosis. DXA standards state T-scores shonld be compared with a white male normative reference database, regardless of ethnicity. BMD determination shonld also be considered for men with a low-tranma fracture, prevalent vertebral deformity, glucocorticoid use, hypogonadism, alcoholism, or poor overall health. Measmement of serum free or total testosterone can also determine if hypogonadism is contributing to bone loss. 

A series of article abstracts about various magnesium-deficiency symptoms, syndromes, conditions, or diseases are supplied at http //www.mgwa-ter.com/abstract.shtml. These include the following alcohol-related hypertension and strokes, alcohol-induced contraction of cerebral arteries, amyofrophic lateral sclerosis and aluminum deposition in the central nervous system, cardiac arrhythmias, asthma therapy, attention deficit disorder (ADD), cerebral artery disorders, constipation, diabetes, heart muscle disorders or myocardial infarction, hypertension, HIV, kidney stones, menopause, migraine, multiple sclerosis, osteoporosis, and premenstrual syndrome. In all cases, an increase in magnesium levels had beneficial effects. 

Chronic alcohol consumption has been implicated in osteoporosis (see Chapter 61). The reasons for this decreased bone mass remain unclear, although impaired osteoblastic activity has been implicated. Acute administration of ethanol produces an initial reduction in serum parathyroid... 

Antacids are used in die treatment of hyperacidity, such as heartburn, gastroesoph eal reflux, sour stomach, acid indigestion, and in the medical treatment of peptic ulcer. Many antacid preparations contain more than one ingredient. An additional use for aluminum carbonate is in die treatment of hyiDeqihosphatemia or for use widi a low phosphate diet to prevent formation of phosphate urinaiy ston. Clalcium carbonate may be used in treating calcium deficiency states such as menopausal osteoporosis. M nesium oxide may be used in the treatment of m nesium deficiencies or m nesium depletion from malnutrition, restricted diet, or alcoholism. 

Low testosterone concentrations frequently are seen in patients with ED, aging, type II diabetes, HIV/AIDS, osteoporosis, depression, obesity, alcohol abuse, anabolic steroid abuse, chronic inflammatory disease, cancer, and glucocorticoid use. 

---