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Osteoporosis and Psoriatic Arthritis: Is There a Connection?

Posted on November 18, 2021
Medically reviewed by
Ariel D. Teitel, M.D., M.B.A.
Article written by
Imee Williams

Psoriatic arthritis (PsA) is a type of inflammatory arthritis that occurs in about 10 percent to 20 percent of people with psoriasis. PsA may affect more than your skin and joints, and several comorbidities (co-occurring conditions) are linked with PsA. Among these comorbidities is osteoporosis, a bone disease that causes the bones to become fragile and break easily.

There are typically no symptoms in the early stages of osteoporosis, which may also be referred to as osteopenia. The first sign or symptom of osteoporosis is typically a bone fracture, a curving spine, or the loss of height.

Compared to the general population, people with PsA have a greater risk of developing osteoporosis. The prevalence of osteoporosis may be as high as 46 percent in people with PsA, and rates in the general population are approximately 10 percent to 20 percent.

This article covers the relationship between PsA and osteoporosis, as well as ways to manage and treat these conditions.

How Are Psoriatic Arthritis and Osteoporosis Related?

There are some possible explanations for the connection between PsA and osteoporosis.

PsA Medications

Medications used to treat psoriatic disease may also contribute to bone loss and osteoporosis.

For instance, corticosteroids that are typically prescribed for treating inflammation have a potential side effect of bone thinning. Experts have studied the effects of antipsoriatic drugs (such as methotrexate) and found them to cause abnormal bone formation and resorption (breakdown). Immunosuppressive agents (such as cyclosporin A) have also been shown to increase the risk of osteoporosis. One study found that cyclosporin A interferes with the bone’s metabolism, including bone growth, bone degradation, and absorption of calcium.

Speak with your doctor about the potential side effects of your PsA medications and have preventive tests or screenings for bone density. People who have taken steroids for several months or longer should also speak with their doctor regarding their bone health.

Physical Inactivity

Physical inactivity related to PsA symptoms such as joint pain, dysfunction, and stiffness may also contribute to the increased risk of osteoporosis.

Vitamin D and Inflammation

The relationship between vitamin D and certain cytokines (proteins involved in inflammation) may contribute to PsA and osteoporosis. Together, vitamin D and cytokines help to maintain and regulate the functions of the skin and bones.

Vitamin D deficiency is a known risk factor for osteoporosis and may also be involved in PsA. One study found that chronic inflammation in PsA was also associated with a deficiency of vitamin D, as well as the overproduction of cytokines. Too little vitamin D and too many inflammatory cytokines likely contribute to the loss of bone mineral density and lead to the development of osteoporosis in people with PsA. Experts are uncertain whether vitamin D and cytokines work together or control each other’s functions.

Other Risk Factors

Additional risk factors that may increase a person’s risk of developing osteoporosis associated with PsA include:

  • Family history of either disease
  • Smoking
  • Obesity
  • Diabetes
  • Depression
  • Menopause
  • Age 30 years or older

If you have PsA and risk factors for osteoporosis, talk to your health care provider to get bone density scans earlier and more frequently.

Managing Psoriatic Arthritis and Osteoporosis

Several approaches may help you decrease your risk of osteoporosis if you have PsA.

Lifestyle Changes and Healthy Habits

Some risk factors for osteoporosis are preventable with lifestyle changes, including:

  • Quitting smoking
  • Decreasing stress levels through meditation or relaxation techniques
  • Doing daily physical activity and maintaining a healthy weight
  • Doing weight-bearing exercises to help strengthen bones and prevent fractures
  • Eating a diet rich in calcium and vitamin D for good bone health
  • Limiting amounts of sodium, caffeine, and alcohol in your diet

Medication

Osteoporosis can be treated by medications such as bisphosphonates to help prevent bone loss and rebuild bones. In postmenopausal women, hormone therapy may also help maintain bone strength.

Talk With Others Who Understand

Dealing with osteoporosis associated with PsA may feel overwhelming at times. However, you are not alone. MyPsoriasisTeam is the social network for people with psoriasis and psoriatic arthritis. Here, more than 99,000 members come together to ask questions, offer support and advice, and meet others who understand life with psoriatic disease.

Do you have osteoporosis with your PsA? Share your experience and tips in the comments below or by posting on MyPsoriasisTeam.

All updates must be accompanied by text or a picture.
Ariel D. Teitel, M.D., M.B.A. is the clinical associate professor of medicine at the NYU Langone Medical Center in New York. Review provided by VeriMed Healthcare Network. Learn more about him here.
Imee Williams is a freelance writer and Fulbright scholar, with a B.S. in neuroscience from Washington State University. Learn more about her here.

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