Connection between Psoriasis and Osteoporosis
Psoriasis, a chronic inflammatory skin condition, and its related autoimmune disease, psoriatic arthritis, have been found to increase the risk of osteoporosis. This bone disease develops when bone mineral density and bone mass decrease, or when the structure and strength of bone changes.
The increased risk is largely due to prolonged inflammation and immune activation, which can lead to painful, itchy skin changes in psoriasis patients. Specific studies suggest an enhanced risk of osteoporosis in people with chronic psoriasis, linking this risk to systemic inflammation, altered bone remodeling, and immune-mediated mechanisms.
Inflammation promotes enhanced osteoclastogenesis (bone resorption) and systemic bone loss, primarily through immune cells like γδ-T cells and cytokine activity. This inflammatory milieu is associated with both erosive joint damage and chaotic new bone formation.
A study involving imaging techniques (F-18 sodium fluoride PET/CT) in PsA patients confirmed ongoing new bone formation in inflamed joints, reflecting active bone remodeling due to persistent inflammation.
Observational studies suggest that patients with psoriasis have a significantly higher incidence of osteopenia and osteoporosis than the general population. Assessment by DEXA scanning at lumbar spine or femoral neck shows a marked reduction in bone mineral density (BMD), supporting clinical suspicion of increased bone fragility risk among these patients.
Systemic inflammation, a hallmark of chronic psoriasis and related autoimmune diseases, is a central driver of bone loss. Elevated pro-inflammatory cytokines such as interleukin-6 and tumor necrosis factor-alpha stimulate osteoclast activity and inhibit osteoblasts, leading to net bone resorption.
Additional lifestyle factors, such as long-term use of systemic corticosteroids, reduced physical activity due to joint pain, smoking, and vitamin D deficiency, likely influence osteoporosis risk in people with psoriasis. Genetic predisposition to psoriasis and psoriatic arthritis may also intersect with genetic determinants of bone metabolism, though specific genetic links to osteoporosis in these patients require further detail.
For people who have already been diagnosed with osteoporosis, medications may be added to lifestyle steps to help support bone health, and extra steps can be taken to prevent falls and fractures. An estimated 3-18% of people with psoriasis develop osteoporosis, which can increase the likelihood of fractures.
Increasing physical activity, quitting smoking, limiting alcohol consumption, and eating a bone-healthy diet rich in calcium, vitamin D, and protein can help improve bone health. A bone density scan may be recommended for women 65 years of age and older, as well as postmenopausal women under 65 who are at increased risk of osteoporosis, including some people with psoriasis.
Up to two-thirds of people with psoriasis may experience osteopenia, a less severe form of bone loss and a potential precursor to osteoporosis. Exercises that take place outside can help increase sun exposure, which can support vitamin D production.
People with psoriatic disease, including psoriasis and psoriatic arthritis, may be more likely to develop osteoporosis or osteopenia compared with those without psoriatic disease. Calcium-rich foods such as low-fat dairy, leafy greens, and whole grains can help provide the nutrients needed for bone health.
Routine screening for osteoporosis is not typically done for men, but a healthcare professional can determine if a bone density scan is needed based on a person's individual risk factors. If calcium or vitamin D levels remain low after taking steps to increase them, a healthcare professional can help determine if a vitamin supplement is needed.
A dermatologist or rheumatologist can help determine if a change of medication is needed to help protect bone health during psoriasis treatment. Research suggests that more targeted psoriasis therapies may protect bone health.
In summary, the specific studies show that chronic inflammation in psoriasis and psoriatic arthritis promotes bone loss and increases osteoporosis risk, mediated by immune activation and cytokine-driven osteoclastogenesis, compounded by lifestyle factors and possibly genetic background. Parallel research in other autoimmune conditions like lupus nephritis supports the importance of inflammation in osteoporosis development.
- The increased risk of osteoporosis in individuals with chronic psoriasis is linked to systemic inflammation, altered bone remodeling, and immune-mediated mechanisms.
- Osteoporosis, a bone disease, develops when bone mineral density and bone mass decrease, or when the structure and strength of bone changes, and it has been found to occur more frequently in people with psoriasis.
- People with psoriatic disease, including psoriasis and psoriatic arthritis, may be more likely to develop osteoporosis or osteopenia compared to those without psoriatic disease.
- For people who have already been diagnosed with osteoporosis, medications may be added to lifestyle steps to help support bone health and prevent falls and fractures.
