Arthritis and Osteoporosis: What Is the Relationship?

Arthritis and osteoporosis are chronic conditions affecting your joints and bones. Arthritis is a broad term that describes over 100 conditions associated with joint pain and inflammation. Osteoporosis is characterized by a loss of bone mass and mineral density, causing bones to become brittle, weak, and prone to fractures. Researchers have linked some forms of arthritis with an increased risk of osteoporosis.

This article explores the connection between arthritis and osteoporosis, including how to treat and manage the conditions together. 

Connection Between Arthritis & Osteoporosis 

Arthritis and osteoporosis are chronic, progressive conditions, meaning symptoms worsen over time. Arthritis means “joint inflammation,” and evidence suggests that inflammation can destroy bone tissue and lead to bone loss associated with osteoporosis.

There are many types of arthritis. Below are examples of specific forms of arthritis linked to osteoporosis.

Rheumatoid Arthritis

Rheumatoid arthritis (RA) is an autoimmune condition that occurs when the immune system mistakenly attacks healthy cells. This leads to joint inflammation, pain, and swelling.

Joints commonly affected by RA include hands, wrists, knees, and hips. Studies have found a strong association between rheumatoid arthritis and osteoporosis. Between 60% to 80% of people with RA also have osteoporosis.

Psoriatic Arthritis

Psoriatic arthritis (PsA) is inflammatory arthritis that causes inflammation in the joints and entheses (where ligaments and tendons attach to bones). About 30% of people with psoriasis — a disease that causes inflamed, scaly patches of skin — develop PsA.

Studies show that people with PsA have an increased risk of osteoporosis and bone fractures than people without PsA. This is especially notable in peopel with PsA with high disease activity and inflammation in the hips.

Axial Spondyloarthritis

Axial spondyloarthritis (axSpA) is an umbrella term that describes inflammatory arthritis affecting the spine, axial joints, and sacroiliac (SI) joints. Chronic inflammation caused by axSpA is associated with new bone formation in the spine and bone loss. Studies show that 12% to 34% of people with axSpa have osteoporosis.

Osteoarthritis

Osteoarthritis (OA), the most common type of arthritis, is a degenerative joint disease that develops when cartilage, a flexible connective tissue that provides cushioning for bones and joints, breaks down.

Research is unclear as to whether or not OA increases the risk of osteoporosis. A 2022 research review found that OA is associated with a higher risk of osteoporosis in the lumbar spine (lower back) and not other bones in the body.

Risks

Arthritis and osteoporosis are both associated with inflammation, which can damage joints, bones, and other body tissues over time. Certain factors can worsen inflammation and increase the risk of osteoporosis and bone fractures, including:

High Disease Activity

Disease activity is the amount of inflammation and severity of symptoms a person with arthritis has. High disease activity can stimulate the production of cells that break down bone, leading to significant bone loss and an increased risk of fractures.

Glucocorticoid Medications

These medications, also known as corticosteroids or steroids, are fast-acting anti-inflammatory medications often prescribed to treat arthritis. Though effective at reducing inflammation, research shows that steroids affect how the body metabolizes vitamin D and calcium. Long-term use has been shown to cause lower bone density and bone loss.

Reduced Physical Activity

Just like muscles, bones become stronger through exercise, particularly weight-bearing and resistance exercises. In addition, joint pain and stiffness can make physical activity difficult, impacting bone density and increasing the risk of osteoporosis. 

Aging

The risk of developing osteoporosis increases as people age, particularly women. When coupled with the impact of arthritis-related inflammation, there is an even greater risk of low bone density and reduced bone mass. 

Health Conditions and Behaviors

Certain health conditions and behaviors increase the risk of developing arthritis and osteoporosis, including:

• Obesity 
• Insulin resistance and type 2 diabetes
• Smoking
• Family history
• Heavy alcohol consumption

Treatment and Management of Arthritis With Osteoporosis 

Though arthritis and osteoporosis are connected, they require different treatments. People with both conditions may see a rheumatologist, a healthcare provider with expertise in managing arthritis and osteoporosis simultaneously. 

Treatments for arthritis vary, depending on the form. Arthritis medications are designed to manage symptoms and slow disease progression. Common arthritis treatments include:

• Analgesics: Pain relievers like acetaminophen (Tylenol) can help reduce mild to moderate pain. 
• Nonsteroidal anti-inflammatory drugs (NSAIDs): Over-the-counter (OTC) and prescription NSAIDs help relieve pain and inflammation. 
• Disease-modifying antirheumatic drugs (DMARDs): These oral or injectable medications can help reduce or stop inflammation to slow the progression of the disease.
• Biologics: There are different types of biologics, and each works differently to stop or slow disease progression. Biologics may be administered by injection or intravenous (IV) infusion. 

Medications for osteoporosis are designed to slow bone loss and promote bone formation to prevent fractures. First-line treatments for osteoporosis include:

• Bisphosphonates are prescribed to prevent bone loss and preserve bone density and strength. They can reduce the risk of fracture by 50%. 
• Selective estrogen receptor modulators (SERMs) are medications that have estrogen-like effects that help promote bone density and reduce the risk of fractures. 
• Teriparatide is a synthetic hormone that stimulates new bone formation, improves bone density, and decreases the risk of fractures. This is given as a daily injection for up to two years. 

Along with taking medications as prescribed for osteoporosis and arthritis, practicing healthy behaviors can help prevent bone loss, reduce the risk of fracture, and control inflammation. Such behaviors include:

• Drinking alcohol in moderation 
• Quitting smoking 
• Participating in regular exercise and physical activity 
• Eating a nutritious diet rich in vitamin D and calcium 

Prevention 

If you have arthritis, there are certain things you can do to keep your bones strong and healthy and prevent osteoporosis. 

Lifestyle Habits 

In addition to treating and managing arthritis and osteoporosis, the following lifestyle habits help prevent the development of both conditions:

• Eating a nutritious diet with plenty of foods rich in vitamin D and calcium 
• Exercising regularly and staying physically active
• Stopping smoking 
• Drinking little to no alcohol 
• Taking arthritis medications as prescribed to keep inflammation under control

Screenings 

Talk to your healthcare provider about your risk of osteoporosis if you have an arthritis diagnosis. They may recommend a test that measures your bone mineral density (BMD).

Bone mineral density tests detect low bone density before osteoporosis develops. Healthcare providers use them to diagnose osteoporosis, assess your risk of fractures, and monitor the effectiveness of osteoporosis treatments.

A dual-energy X-ray absorptiometry (DXA) is the most common and reliable test to measure bone mineral density. The DXA uses a scanner to take X-rays of your body and measure your BMD. 

Symptoms to Watch For 

Osteoporosis develops slowly over time; it is a “silent disease” that many people don’t know they have until they break a bone. As a result, osteoporosis symptoms, such as tooth loss and back pain, may be attributed to another cause or mistaken for arthritis-related pain.

Talk to your healthcare provider if you develop sudden severe back pain, loss of height, or a stooped-over posture (kyphosis). These are symptoms of a spinal vertebrae fracture. Fractures can result from a minor fall or even bending, coughing, or lifting in people with osteoporosis.

Summary 

Arthritis and osteoporosis are chronic, progressive diseases affecting joints and bones. Research shows that inflammation — a key feature of arthritis — can destroy bone tissue, leading to bone loss and an increased risk of fractures (broken bones). Screening tests can look for early signs of bone loss. Your healthcare provider can prescribe medications that promote bone growth or prevent bone loss to prevent or treat osteoporosis.

A Word From Verywell 

Arthritis has strong connections to osteoporosis, particularly in post-menopausal women and those with a family history of osteoporosis or a personal history of fractures. If you have arthritis and osteoporosis, you can manage symptoms of both conditions through medications and healthy habits to keep your bones healthy and strong.