Osteoporosis and Inflammatory Bowel Disease: What You Need to Know

While inflammatory bowel disease (IBD) impacts your gastrointestinal (GI) tract, osteoporosis 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 IBD, bone health may not be top-of-mind — but it has been linked with osteoporosis. Here’s why you should also find ways to preserve your bone health. 

The Link Between IBD and Osteoporosis 

IBD in an umbrella term for chronic inflammatory conditions that affect your GI tract, such as Crohn’s disease and ulcerative colitis. It leads to a range of digestive symptoms that come and go, like abdominal pain and frequent bowel movements. And it’s common — IBD affects about 10 million people worldwide. 

IBD also increases your risk of other health conditions — from migraine to heart disease to cancer. Research shows an association between IBD and bone loss, which can lead to osteoporosis and an increased risk of bone fracture. “Inflammatory bowel disease itself does not cause osteoporosis,” says Abhik Bhattacharya, MD, gastroenterologist and IBD specialist at The Susan and Leonard Feinstein IBD Center, Mount Sinai Health System in New York City. Instead, a few factors come into play. 

IBD Medications 

One of the most commonly used IBD treatments is prednisone, which is a very potent corticosteroid, says Bhattacharya. It acts very quickly and works to suppress the immune system, he adds.  

But corticosteroids can also come with side effects like bone loss, particularly when used in high doses over time. According to the Crohn’s and Colitis Foundation, 30 to 50 percent of people who use corticosteroids long-term develop osteoporosis. Though that risk varies depending on the dosage and the length of corticosteroid use.  

According to Bhattacharya, the largest risk comes from taking 20 or more milligrams (mg) of corticosteroids for a period of three months or more. “Over a lifetime of any patient, they can lead to a decrease in bone deposition,” he says. “This is synonymous with what we know as osteoporosis.” 

What’s more, researchers have found that, even long-term use of lower doses (5 mg) of prednisone can lead to bone loss. 

Underlying Inflammation 

IBD is an inflammatory disease, meaning it involves inflammation in the GI tract. This inflammatory response can disrupt the natural pace at which old bone is removed and new bone is formed. And when IBD is active, it increases the risk to your bone health. 

Research shows that taking anti-inflammatory medications to control IBD may help reduce negative effects of inflammation on bone health. However, studies show that when you combine anti-inflammatory medications with steroids, the steroids still pose a risk to your bone health. 

Vitamin D Deficiency 

Studies have found that IBD can lead to malabsorption, resulting in vitamin D deficiency. However, vitamin D helps your body absorb calcium—and both of these essential nutrients help promote strong, healthy bones. 

Osteoporosis Risk Factors 

“The other risk factors [for osteoporosis] would be whatever risk factors are present in general population,” says Bhattacharya. 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: Long-term use of steroids or anticonvulsants can 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. 
• 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. 

Tips to Manage IBD and Protect Your Bones 

“The number one thing is to make sure that your disease is always in remission,” says Bhattacharya. “Follow up with your doctors regularly. Take your immunosuppressant medication. Make sure your disease is in remission so that you never request steroids.” 

Aside from that, “just maintain a regular healthy lifestyle,” he adds.  

Eat a Healthy, Nutritious Diet 

Proper nutrition can help you manage IBD, prevent nutritional deficiencies or malnutrition, and maintain a healthy weight. 

While there’s no one diet to ease IBD and promote bone health, plan to eat a well-balanced diet full of foods you can tolerate, such as low-fiber fruits and vegetables and lean protein. Aim to also get plenty of calcium and vitamin D 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. 

Stay Active 

When you’re dealing with IBD symptoms, exercise may be the last thing on your mind. But evidence suggests that staying active can help you manage your condition.  

Research has also found that resistance exercises in particular — such as weightlifting — can help preserve bone health and muscle mass. However, low-impact exercises — like walking or riding a bike — are best for people who have osteoporosis, as they don’t overtax the joints. Read more about exercises to avoid for osteoporosis. 

Maintain a Healthy Weight 

IBD symptoms like persistent diarrhea can lead to weight loss. And being underweight can weaken bone health and increase your risk of osteoporosis.  

Be sure to eat a healthful diet to help you avoid malnutrition. Try to reach and maintain a healthy weight to promote optimal bone health. 

Quit Smoking 

Smoking is bad for your health in many ways. It can harm your digestive tract as well as weaken bones and increase fracture risk.  

If you smoke, quitting can help decrease IBD activity and reduce the risk of bone loss and fractures. One study shows that quitting may help increase bone mass previously lost due to smoking.  

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

Avoid Alcohol  

Evidence suggests that alcohol may contribute to inflammation when you have IBD. Research has also found that chronic, excessive alcohol consumption increases osteoporosis risk.  

Many people who have IBD tend to avoid alcohol altogether, as it tends to worsen IBD symptoms. Though mild consumption may have a negligible impact. If you do drink, be sure to so in moderation: That means one drink a day (or less) for women, and two (or less) for men. 

When to Talk to Your Doctor About Bone Health 

“If you have IBD and you’ve been on steroids, ask your doctor about osteoporosis immediately, and let the doctor decide based on the risk factors whether they need to be screened,” says Bhattacharya.  

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 is typically 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 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.