I share a lot of things with my parents. One I didn’t anticipate sharing was bone density. Yet here I am at 55 with advanced osteoporosis.
Many physical diseases are co-morbid with bipolar disorder. 60% of the early mortality attributed to the disorder is due to co-morbid chronic physical illnesses. But bone density? Really?
Antipsychotics and anticonvulsants both contribute to poor bone health. I take one of each, so they must be the culprits.
But the full story is more complicated.
Last year I was diagnosed with celiac disease. Celiac disease causes malabsorption of nutrients, especially calcium. Healthy calcium intake contributes to healthy bone density. So if I’m not getting enough calcium that must be the problem, right?
My endocrinologist, after tempering his surprise at how far along my loss of bone density was for a man my age, laid out three possibilities. The cause of my osteoporosis could be the celiac disease, or it could be the bipolar disorder, or maybe I was just born this way.
On pressing him he revealed that he doubted it was the celiac or heredity.
I asked my psychiatrist about the effects of my medicine. He said the anticonvulsant, Lamotrigine, and the antipsychotic, Ziprasidone, that I take do not include significant bone loss as a side effect (other anticonvulsants and antipsychotics do).
He expected the endocrinologist would point his finger at my psych meds, but was glad that that doctor included the meds as only one of three possibilities.
As with so many other topics concerning bipolar disorder, especially older people with bipolar disorder, there’s really not that much solid research to look at. Just this year a meta analysis of research published by the NIH found an increased risk of fractures in people with bipolar disorder. But no studies investigating bone quantity or quality and bipolar disorder were identified.
However, there is a lot of research on depression, and there seems to be a strong link between osteoporosis and depression.
The NIH reports that bone mineral density in subjects with depression is 7.3% lower than density in individuals without depression. Depression is associated with a 52% increase in bone fracture.
Unfortunately, this research doesn’t shed a lot of light on my condition.
We can’t authoritatively state that these numbers will repeat in a study of individuals with bipolar disorder. One reason is that loss of bone density in individuals with depression could be attributable to SSRIs. Many of those of us with bipolar disorder 1 can’t go near SSRIs.
I have to be pragmatic. I have osteoporosis and I have to live with it no matter what caused it. In my mind and in my bones I’m brittle.
So I have another medicine to take and I have to be careful about falling. Managing bipolar disorder places limits on each affected person, and it forces a lot of choices about behavior. I just didn’t anticipate that one of those choices would be whether or not to go ice skating with my daughter.