Causes of Osteoporosis in Lyme Disease

DEXA scan osteoporosis lyme disease

A DEXA Scan can reveal osteoporosis development

There are many ways in which Lyme disease can contribute, directly or indirectly, to osteoporosis development, such as adverse effects on the thyroid gland, and parathyroid gland. Although there is little evidence that Lyme disease has a direct effect on thyroid function there are certainly many patients living with hypothyroidism and Lyme disease. Many people with thyroid dysfunction, whether an under- or overactive thyroid gland, remain undiagnosed and it may be that in suffering the symptoms of Lyme disease they also receive a diagnosis of hypothyroidism, Hashimoto’s thyroiditis, or hyperthyroidism. Medications used to manage thyroid conditions, and the thyroid dysfunction itself, may adversely affect bone health by interfering with the assimilation of calcium into new bone tissue, or by causing the body to leach calcium from the bones to balance the acidity of the blood or participate in essential bodily functions such as muscle contraction and nerve signalling.


Lithium and Osteoporosis in Lyme Disease

Patients with abnormal cognitive function and mood irregularities, which have been observed in some Lyme disease cases, may be given lithium to treat the condition. Periods of euphoria and energy, followed by depression and fatigue are familiar to many with cognitive symptoms of Lyme disease and may be diagnosed as bipolar disorder. Bipolar disorder is commonly treated with lithium which can increase the production of parathyroid hormone and lead to the increased turnover of bone tissue. Lyme disease osteoporosis may then be a result of misdiagnosis with a psychiatric condition and the harmful side-effects of prolonged, and possibly inappropriate, medication such as lithium.

Indigestion Medications (Antacids) and Osteoporosis in Lyme Disease

Lyme disease patients may experience stomach upsets, nausea, vomiting, and acid reflux (heartburn) at some point during their illness and these patients may take medications to help control such symptoms. Unfortunately, many indigestion medications used to control stomach acid contain aluminium which can interfere with calcium absorption, as well as having other adverse effects. Common acid-reflux (antacid) medications that have an aluminium base include: Aludros, Amphojel, Gaviscon, Gelusil, Kolantyl, Maalox, Mylanta, and Riopan. Fortunately, there are many other antacid medications that can actually aid in bone health given the right conditions as they contain calcium, magnesium, or both in some cases. Non-aluminium-based antacid medications include Rolaids, Titralac, and Tums, all of which contain calcium carbonate, a supplement sometimes used to boost bone calcium levels and address osteoporosis.


Some patients may wish to switch to a protein-pump inhibitor (PPI) to control acid levels during treatment with antibiotics as some mineral based antacids can interfere with antibiotic metabolism by bonding to the medication in the gut before it has a chance to function in the body. PPIs can also adversely affect bone health when taken for long periods of time however and are sometimes associated with osteoporosis development. Addressing the cause of the excess stomach acidity is much more likely to be beneficial in the longer term. Stress, infection with Helicobacter pylori, mineral deficiencies, and other bacterial or viral infection can all contribute to excess gastric acid.

Treating Lyme disease successfully can, in turn, remove the need for antacid medication as gastrointestinal function may simply normalize following eradication of the infection. Patients having been treated with long regimens of antibiotics may have incurred permanent damage to their gastrointestinal tract however, with alterations in the immune system function possible. Such changes may lead to the development of malabsorption issues, with vitamin D, calcium, and magnesium possible affected. Patients with celiac spure, and primary biliary cirrhosis, are also likely to suffer from absorption problems which can affect bone health and lead to osteoporosis.

Calcium for Osteoporosis – Ask Your Doctor First

Patients being treated for Lyme disease with antibiotics should discuss their concerns regarding bone health with their physician. Most short courses of antibiotics lasting less than a month pose little threat to bone health, but patients being treated for longer than a month with one or more Lyme disease antibiotics may be at a higher risk of osteoporosis or osteopenia. A physician may prescribe other supplements to counteract the possible negative effects of medications, and/or diagnostic monitoring through DEXA scans. A DEXA scan is a Dual-emission X-ray absorptiometry (DXA/DEXA) which measures bone mineral density (BMD). This type of scan does not, however, have the sensitivity to diagnose certain metabolic diseases which can affect the healing of bones from fractures, infections, or tumors (a nuclear bone scan is needed for such cases).

It is important to note that calcium supplements are not necessarily advisable for all patients as there are associations between adverse cardiac events and excess, inappropriate calcium intake. Calcium can contribute to plaque formation in the arteries and has a role in high blood pressure (hypertension). Indeed, calcium-channel blockers may be prescribed for some patients with high blood pressure, which can also be a symptom of Lyme carditis. Staving off possible Lyme disease osteoporosis is further complicated then by the multi-system effects of the disease, requiring thorough investigation, careful diagnosis, and intelligent management.


References

Golub, L.M., Lee, H-M., Stoner, J.A., Reinhardt, R.A., Sorsa, T., Goren, A.D., Payne, J.B., (2010). Doxycycline Effects on Serum Bone Biomarkers in Postmenopausal Women, J Dent Res., 89(6), pp.644–649.

Sasaki T, Kaneko H, Ramamurthy NS, Golub LM. (1991). Tetracycline administration restores osteoblast structure and function during experimental diabetes. Anat Rec., 231(1), pp.25-34.

Williams S, Wakisaka A, Zeng QQ, Barnes J, Seyedin S, Martin G, Wechter WJ, Liang CT. (1998). Effect of minocycline on osteoporosis. Adv Dent Res., 12(2), pp.71-5.