• Women with spondyloarthritis (SpA) have a high risk of developing osteoporosis.
• The risk for osteoporosis is highest in women over 50, particularly after menopause.
• An active lifestyle, healthy diet and habits, and proper levels of calcium and vitamin D can lower your risk of osteoporosis.

Women have a higher risk than men of developing osteoporosis, and that risk increases with a diagnosis of axial spondyloarthritis (axSpA) — a chronic, inflammatory form of arthritis that primarily affects the spine, hips, and rib cage. In general, the prevalence of osteoporosis is four times higher in women than in men.

Studies show that women experience SpA differently than men. Having a higher risk for osteoporosis is one difference that can affect your health in significant ways. It’s important for women with SpA to understand their risk for osteoporosis and what steps they can take to protect their bone health.

Understanding Your Risk of Osteoporosis With SpA

SpA is a risk factor for bone fractures in both men and women. Researchers don’t fully understand the links between SpA and osteoporosis. However, SpA is associated with both excess bone formation — which can cause bone damage and fusing of bones — and with bone loss, which is a sign of osteoporosis.

These contradictory effects make it difficult to diagnose osteoporosis with axial spondylitis. New technologies for bone scanning are proving to be more effective. Likewise, women with axSpA often experience delayed diagnosis of the condition because doctors, historically, have mistakenly linked SpA more to men.

Symptoms between the two conditions can also overlap. Symptoms of osteoporosis include:

• Changes in posture such as stooping or bending
• Loss of 1 inch of height or more
• Lower back pain
• Unusual fractures, especially in the hip, spine (vertebral fractures), or wrist

Since these can also be symptoms of spondyloarthritis, it may be difficult to know whether osteoporosis is involved and may even be worsening axSpA symptoms.

How Spondylitis Contributes to Osteoporosis

Scientists believe a number of factors contribute to osteoporosis in people with axSpA, depending on disease duration. These factors include:

• Decreased spine mobility
• Higher levels of proinflammatory proteins due to disorders in the immune system
• Sedentary lifestyle
• Malabsorption of minerals in cases where inflammatory bowel disease (IBD) also occurs, which can also contribute to anemia (low levels of red blood cells) and fatigue

In a study with 204 participants ages 50 and up with ankylosing spondylitis (AS), a severe form of axSpA, researchers found the women were at more than twice the risk of developing osteoporosis than the men — 30 percent vs. 14 percent.

Other Risk Factors for Osteoporosis

Some other risk factors for osteoporosis include:

• Low body weight
• Family history
• Low calcium levels
• Alcohol consumption of more than two drinks per day
• Smoking

Spondylitis Treatment and Osteoporosis

Medications used for treating SpA may also affect a person’s risk of developing osteoporosis. Researchers have found a link between corticosteroid treatments and an increased risk of osteoporosis in people with axSpA.

Meanwhile, SpA treatment with some biologic disease-modifying antirheumatic drugs (DMARDs) has been shown to help prevent low bone density and protect against osteoporosis. DMARDs can help reduce disease activity and disease progression in rheumatic conditions like SpA and rheumatoid arthritis.

In a recent study with more than 5,000 women, use of nonsteroidal anti-inflammatory drugs (NSAIDs) was associated with reducing or eliminating the benefits of oral bisphosphonates, a class of drugs that are frequently used to treat osteoporosis. NSAIDs are typically used in the treatment of axSpA. The study showed that NSAIDs in general do not have an adverse effect on bone health. However, one study showed that NSAIDs taken after a hip fracture may increase the risk of a second hip fracture.

Ways To Lower Your Risk for Osteoporosis

There are many ways you can lower your risk of osteoporosis and take steps to preserve bone mineral density. Here are some ways you can reinforce your bone health, help reduce the risk of fractures, and improve your overall health and quality of life.

1. Choose Foods That Build Bones

Research shows that a diet rich in fruits, vegetables, fish, whole grains, legumes, and low-fat dairy can help strengthen bones. This type of bone-friendly diet is similar to an anti-inflammatory diet, which many MySpondylitisTeam members report helps ease their axSpA symptoms.

Calcium and vitamin D are essential for bone health. Your body needs adequate levels of calcium for bone health as well as proper functioning of the heart, blood, muscles, and nerves.

Calcium-rich foods include:

• Dairy products, such as milk, cheese, and yogurt
• Sardines
• Tofu enriched with calcium
• Green vegetables

You also need adequate levels of vitamin D in order to properly absorb calcium. Vitamin D can be absorbed through sunlight, diet, or supplements.

Some milk products are fortified with vitamin D. Other foods that are high in vitamin D include:

• Liver
• Saltwater fish
• Egg yolks

2. Consider Calcium and Vitamin D Supplements

Most people do not get enough calcium from diet alone. The recommended calcium for women over 50 is 1,200 milligrams per day. For men, it is 1,000 milligrams per day.

In general, people under 70 need 600 international units (IU) of vitamin D per day. Those over 70 need 800 IU. Low vitamin D levels are more common in people with spondyloarthritis.

Talk to your doctor to determine whether you should be taking calcium or vitamin D supplements, which dosage will be safest and most effective for you, and how to choose a quality supplement product. Note that some supplements can cause side effects or dangerous interactions with medications in high dosages.

3. Get Plenty of Physical Activity and Exercise

Staying physically active and exercising can help strengthen bones. Several different types of exercise are important for bone health:

• Weight-bearing exercise, which uses your body weight for resistance, including walking, dancing, and playing tennis, among other activities
• Exercises for building muscle, such as weight machines, lifting weights, or using resistance bands
• Balance exercises to help prevent falls, such as yoga or tai chi
• Flexibility exercises for range of motion, such as stretching, which you should do before exercising

If your mobility is limited, ask your doctor for a referral for physical therapy to help you find exercises that are safe and effective for you.

4. Cut Back on Unhealthy Habits

Some habits are detrimental, both for your bones and your general well-being. Along with getting good nutrition and exercise, it’s important to cut down on habits that contribute to bone loss. As you evaluate your lifestyle, consider making these changes to protect your bones and overall health:

• Quit smoking. Among the benefits of quitting smoking, it can improve spondylitis symptoms and make you more responsive to some spondylitis treatments.
• Avoid excessive alcohol consumption.
• Cut back on sugar and sugar-sweetened drinks.
• Avoid processed snack foods, fried foods, and processed meats.

Start with small changes and set realistic goals. Even if you can’t give up some habits, cutting down is worthwhile. If you need help changing your habits, your doctor can give you a referral for a dietitian or counselor.

5. Talk to Your Doctor About Bone Health

If you have concerns about your risk for osteoporosis, start a conversation with your doctor. They can help decide whether you need a dual-energy X-ray absorptiometry (DEXA) bone density scan to evaluate your bone health. If you show signs of osteoporosis or osteopenia (a milder form of bone loss), your doctor can determine whether medications to treat bone loss may be appropriate.

Talk With Others Who Understand

On MySpondylitisTeam, the social network for people with spondylitis and their loved ones, more than 87,000 members come together to ask questions, give advice, and share their stories with others who understand life with spondylitis.

Are you living with spondylitis? Do you have questions about osteoporosis? Share your experience in the comments below, or start a conversation by posting on your Activities page.