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Psoriatic Arthritis and Osteoporosis: Is There a Connection?

Medically reviewed by Ariel D. Teitel, M.D., M.B.A.
Written by Imee Williams
Posted on December 13, 2021

Osteoporosis is a bone disease that causes the bones to become fragile and break easily. It is also associated with related conditions such as arthritis. More than 95 percent of adults living with osteoporosis have at least one comorbidity (co-occurring condition), and compared to the general population, adults with osteoporosis have more than twice the risk of arthritis. Psoriatic arthritis (PsA) is a type of inflammatory arthritis that’s seen in about 20 percent of people with osteoporosis.

PsA can develop slowly or very quickly. The first signs or symptoms of PsA are typically swelling, stiffness, and pain in the joints, especially in the hands, feet, knees, hips, and back. “I have osteoporosis and psoriatic arthritis in my hip. I have not had any fractures but do have the pain and stiffness,” shared one MyOsteoTeam member.

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

Several factors may explain the connection between osteoporosis and PsA.

Physical Trauma

Over time, osteoporosis leads to low bone density and increases the risk of bone fractures. Physical trauma in the bones — like that sometimes resulting from osteoporosis — may increase the risk of PsA. Hip fractures, in particular, are one of the more common and severe risks of osteoporosis. A small-scale study found that about 37 percent of people with osteoporosis had PsA in their hip region.

Vitamin D and Inflammation

An interaction between vitamin D and specific cytokines (proteins involved in inflammation) may contribute to osteoporosis and PsA. 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 PsA. One study found that chronic inflammation in PsA was associated with a deficiency of vitamin D and the overproduction of cytokines. Too little vitamin D and too many inflammatory cytokines likely contribute to decreased bone mineral density and the development of PsA in people with osteoporosis. Experts are uncertain whether vitamin D and cytokines work together or control each other’s functions.

Other Risk Factors

Osteoporosis and PsA also share some risk factors, which may increase the risk of developing both conditions. Additional risk factors of PsA include:

  • Family history of the disease
  • Smoking
  • Obesity
  • Diabetes
  • Age 30 years or older
  • Emotional or physical stress

If you have osteoporosis and risk factors for PsA, talk to your health care provider about a referral to a rheumatologist (a doctor who specializes in systemic rheumatic diseases such as PsA, rheumatoid arthritis, and ankylosing spondylitis).

Managing Osteoporosis and Psoriatic Arthritis

Decreasing your risk of PsA or treating comorbid PsA and osteoporosis may involve lifestyle changes and medication.

Lifestyle Changes and Healthy Habits

Some risk factors for PsA 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

PsA and its symptoms may be managed with certain medications, including:

  • Nonsteroidal anti-inflammatory drugs
  • Disease-modifying antirheumatic drugs, which can help slow disease progression
  • Other biologics
  • Corticosteroid injections

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

Read more about osteoporosis treatments.

Talk With Others Who Understand

Dealing with PsA associated with osteoporosis may feel overwhelming at times. However, you are not alone. MyOsteoTeam is the social network for people with osteoporosis. More than 59,000 members come together to ask questions, offer support and advice, and meet others who understand life with osteoporosis and osteopenia.

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

Posted on December 13, 2021
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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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