GI Problems and Bone Health

Osteoporosis (weak bones) is not a natural part of aging. It is a disease. Osteoporosis is a bone disorder characterized by compromised bone strength that is prone to increased risk of fracture from low impact trauma or a fall from standing height. Several conditions may cause this increased risk of fracture. Some of the more common diseases are celiac disease, Crohn’s disease, malabsorption of nutrients, rheumatoid arthritis, hypogonadism, and type 1 diabetes mellitus. The good news is that through proper treatment you can slow down or prevent this debilitating disease, which can take your independence through spinal collapse or hip fractures. Research shows that for various reasons, some individuals choose not to initiate the recommended treatment, and do not discuss their hesitations with their physicians.

Have you ever chosen not to start a treatment because of pre-existing gastrointestinal concerns? What was the outcome? Did the disease continue to be an issue? Will the lack of treatment show up in 10 years? Did it go away without an intervention?

Researchers studied women with osteoporosis to examine reasons for not initiating osteoporosis therapy among a managed care population.1 This study reports that of those women diagnosed with osteoporosis and whose physicians recommended osteoporosis treatment, 38% did not initiate treatment within two years of diagnosis. Interestingly, they found that the most common reasons for not initiating recommended osteoporosis treatments were pre-existing gastrointestinal concerns and worry over side effects of osteoporosis treatment and medication costs.

Many medications list nausea, diarrhea, gastric upset, constipation, etc., as side effects. This study showed pre-existing gastrointestinal concerns is a common reason for not initiating treatment but there may be other solutions available, so talk with your doctor.

It is important to understand both the benefits and risks in the context of your beliefs toward taking medication.2 Be aware that response to medication can vary with age, medical history, lifestyle, and whether you take the medication as directed. Your physician or health care professional prescribing the medication will look at all these factors. Using their training and experience, they will discuss medication benefits and risks along with your stated concerns and then recommend the treatment that they believe will offer the greater benefit over risk while addressing your health issues.

If you accept a prescription, then the physician expects you will adhere to the treatment, which is to take the medication as directed for the length of time prescribed. However, non-adherence is widespread and an issue for many chronic disease states, including osteoporosis.3,4

Health care is constantly changing. Today we need to use our inter-professional team of physicians, pharmacists, nurses, physiotherapists, and dietitians to support and educate us as patients. As The Osteoporosis Book: Bone Health points out, it is important that you be a participant in your own health care, as you bring unique knowledge to the team. You are the expert in how you behave, what you believe, and what you will and will not do to reach your desired outcome. For example, if the doctor says that the medication you need requires a needle every day and you dislike needles and will not follow through, then discuss that with your team. You are not the first person to dislike needles.5 Also, if you have had experience with or have heard that certain medications cause gastrointestinal upset, then talk with your doctor or pharmacist. Follow up with the team, as they might have other options or ideas on how to manage this issue. With osteoporosis medication, some side effects decrease simply by drinking enough water before and after you take the drug, or by choosing a different route of administration. For example, some medications come in a variety of formats, such as injection, intravenous, and oral therapy. If necessary, discuss a compromise so that you can meet, or come as close as possible to, the desired goal, which is continued or improve health and wellbeing.

As the prime team member, go prepared to your appointments. Keep a folder with your medical history, family history, medications, and any test or X-ray results you might have. Write down your questions in priority so you cover your most important questions first.

Remember, your physician or other team members see hundreds of people in a year, where as you likely have the valuable, but limited, experience of one. Work with your team to help you find an acceptable compromise for your gastrointestinal tract or other problems that can affect how you care for your health.

Gwen Ellert, MEd, RN
Nurse Educator
First published in the Inside Tract® newsletter issue 196 – 2015
Image Credit: © Media Ltd
1. Yu, J., Brenneman, S.K., Sazzonov,V., Modi, A.. (2015). Patient and Preference. 5,9 821-830.
2. Lau, E., Papaioannou, A., Dolovich, L., Adachi, J., ET AL (2008). Patients’ adherence to osteoporosis therapy: Exploring the perceptions of postmenopausal women. Can Fam Physician. 54, 394-402.
3. Josse, R.G., (2011). Adherence to osteoporosis treatment. CPJ. 144 (SUPPL 1), S21.
4. The National electronics Library for Medicine. Medicines Management Overview. March 2013. Adherence with Prescribed Medications: An annotated bibliography of publications from 2012.
6. The Osteoporosis Book: Bone Health 4th edition (2016). Trelle Enterprises Inc. Sandhill Distributors.