Illustration of asthma and osteoporosis
Credit: Tatiana Ayazo

While asthma impacts your lungs, osteoporosis is a condition that affects your bones. It causes bones to become weak, brittle, and break more easily. And it’s common: Osteoporosis is thought to affect more than 200 million people across the globe.  

If you have asthma, bone health may not be top-of-mind — even though asthma has been linked with osteoporosis. Here’s why  finding ways to preserve your bone health can be a key part of your overall treatment plan.  

The Link Between Osteoporosis and Asthma 

“Osteoporosis is a comorbid condition of asthma,” says Richard F. Lockey, MD, Distinguished University Health Professor and Joy McCann Culverhouse Chair of Allergy and Immunology at the University of South Florida Morsani College of Medicine. The main contributing factor linking the two conditions: asthma medications.  

Asthma Medications and Osteoporosis 

Prescription steroids are one of the main types of asthma treatment. These medications work by decreasing inflammation in the airways to help control asthma symptoms like wheezing and difficulty breathing. But they do come with risks. “Osteoporosis is a huge problem secondary to the use of glucocorticosteroids,” says Lockey.  

A review published in 2021 by Lockey and colleagues notes that up to 50 percent of those who use glucocorticoid to treat asthma long-term experience bone fractures. And fractures increase osteoporosis risk. 

Steroid medications used to treat asthma can either be taken orally or inhaled.  

When taken orally, glucocorticosteroids are known to: 

  • Decrease calcium absorbed from food 
  • Increase calcium loss from kidneys 
  • Decrease bone formation 
  • Increase bone loss 
  • Impact the production of sex hormones that otherwise provide protective bone benefits  
  • Lead to muscle weakness, increasing the risk of fall-related fractures 

Inhaled steroids also come with an increased risk of osteoporosis. One study found that the risk of osteoporosis was significantly higher in those with asthma who took inhaled steroids compared to those who weren’t on these medications. 

With all the above in mind, many medical professionals emphasize the importance of using steroids at the lowest possible dosage when treating asthma to help mitigate these risks.    

Osteoporosis Risk Factors 

Many other factors outside of asthma play a role in the development of osteoporosis. These can be broken into two groups: uncontrollable and controllable risk factors. 

Uncontrollable risk factors for osteoporosis include:  

  • Gender: Osteoporosis is more common in women, especially in perimenopausal women. 
  • Ethnicity: Osteoporosis is more common in Caucasian and Asian women. 
  • Age: The older you get, the higher your risk of developing osteoporosis. 
  • Family history: If an immediate family member, like a parent, has osteoporosis, your risk of developing it increases. 

Controllable risk factors, or those you can modify, include: 

  • Medications: Aside from steroids, other medications like anticonvulsants may also contribute to osteoporosis. 
  • Diet: Low calcium and vitamin D intake may contribute to osteoporosis risk. 
  • Inactivity: Not exercising regularly or being inactive can weaken your bones whether you have asthma or not. 
  • Weight: Being underweight (or having a small body frame) can impact bone health. 
  • Smoking: Smoking cigarettes makes you more prone to osteoporosis and bone fractures. 
  • Alcohol: Excessive alcohol consumption impacts how the body absorbs calcium and vitamin D, both of which are critical for healthy bone development. 

By familiarizing yourself with the many risk factors tied to osteoporosis, you can have an informed conversation with your health care provider about your personal risk and what you can do to protect your bones. 

Osteoporosis Symptoms  

Osteoporosis is sometimes referred to as a “silent” condition. That’s because it often has no symptoms.  

As it progresses, it can lead to symptoms like  

  • Back pain 
  • Sudden back pain 
  • Joint pain 
  • Changes in posture 
  • Stooping or loss of height 

But most people aren’t aware they have osteoporosis until they fracture or break a bone. That’s why it’s so important to be aware of osteoporosis and take steps to protect your bone health.  

How to Manage Asthma and Protect Your Bones 

These strategies can help you manage asthma and keep your bones healthy.  

Eat a Healthy, Nutritious Diet 

Research shows that poor dietary habits can contribute to the progression of osteoporosis — but  adopting healthier eating habits may help decrease disease progression. What’s more, proper nutrition may also help minimize asthma symptoms. 

Plan to eat a well-balanced diet full of fruits, vegetables, fish, whole grains, and legumes. Aim to also get plenty of calcium and vitamin D — which can be found in dairy products like milk, cheese, and yogurt — to help preserve bone strength. 

Women ages 50 and under and men ages 70 and under should aim to get 1,000 mg of calcium each day and increase intake to 1,200 mg each day once women reach age 51 and men reach age 71. The recommended vitamin D intake is 400-800 IU a day for most adults under age 50, and 800-1,000 IU a day for those 50 and up.  Talk to your doctor before taking changing your diet or taking supplements.

Stay Active 

When you have asthma, exercise may be the last thing on your mind. In fact, some people experience exercise-induced asthma or asthma symptoms that occur when being active. But when asthma symptoms are well-controlled, exercise can actually improve lung health.  

What’s more, exercise is also a key strategy for improving bone health and preventing osteoporosis. While incorporating a mix of activities into your workout plan is best for your overall health, when it comes to bone health, weight-bearing activities are especially important. Research has found that resistance exercises in particular can help preserve both bone and muscle mass.  

Just don’t overdo it. If you experience asthma symptoms while working out, stop immediately and take your rescue medication. Talk to your doctor before starting a new exercise plan. 

Maintain a Healthy Weight 

Obesity may contribute to osteoporosis risk in people with asthma. “If your asthma is not under control, you’re going to be much more inactive,” says Lockey. “Theoretically, inactivity leads to obesity, which can protect against osteoporosis.”  

Meanwhile, a known risk factor of osteoporosis is being underweight. Studies have even shown that those who are overweight tend to have a higher bone mineral density. But research has also linked obesity with a faster progression of bone frailty, which may increase fracture risk. 

“Obesity also leads to inactivity, which decreases bone formation,” adds Lockey. 

Eating a healthy diet and staying active may help you reach and maintain a healthy weight, which can help with asthma symptoms and promote bone health. Aim for a BMI between 18.5–24.9 to lower your risk of asthma-related complications attacks and osteoporosis. Work with your doctor to find a healthy weight for you.  

Quit Smoking 

Smoking is bad for everyone. But having asthma makes your lungs particularly sensitive to cigarette smoke, which irritates the lungs and may trigger an asthma attack. Research shows that people with asthma who smoke experience worsened outcomes compared to nonsmokers and former smokers, including more severe asthma symptoms, an accelerated decline in lung function, and reduced responses to corticosteroids. 

Smoking can also contribute to weakened bones and increased fracture risk. What’s more, many people who smoke also partake in other unhealthy lifestyle habits that affect bone health, like decreased activity levels and poor diet. The good news? Findings from one study show that quitting may help increase bone mass previously lost due to smoking.  

Ask your doctor if you need help with quitting smoking. You may benefit from the use of a smoking cessation aid.  

Moderate Alcohol Use 

Alcohol is another known asthma trigger. Research also shows that chronic, excessive alcohol use also increases osteoporosis risk. What’s more, heavy drinking has been linked with a decrease in bone density and weakened bones. Additionally, those who drink alcohol excessively are also more likely to partake in other unhealthy lifestyle habits that affect bone health, including smoking and poor eating habits. 

Talk to your doctor about your drinking habits and whether you should cut back on alcohol consumption to improve your overall health.  

When to Talk to Your Doctor About Bone Health 

Because there are often no symptoms of osteoporosis until a bone breaks, routine screening can help prevent osteoporosis. Screening is easy and only takes five to 10 minutes. Early detection can help you take proper steps to prevent fractures and promote bone health.  

Routine screening for osteoporosis should be done:   

  • After age 65 for women, 70 for men, or sooner depending on your personal risk factors 
  • Every one or two years, or more often depending on your health  
  • After a bone fracture in those over the age 50 
  • When taking new medication associated with low bone mass or bone loss 

Talk to your doctor at your next health exam about getting screened for osteoporosis.  

This article was made possible with support from Amgen. 


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