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Osteoporosis and Axial Spondyloarthritis

Reviewed by: HU Medical Review Board | Last reviewed: May 2020

There are various conditions or diseases that occur at the same time as conditions on the AxSpA spectrum. These are called comorbid conditions. Some of these are more common than others, and early diagnosis of these disorders can help you get prompt treatment and improve symptoms and quality of life.

Osteoporosis is one of the comorbid conditions that commonly occurs with conditions on the AxSpA spectrum. Knowing more about it and its symptoms can help you get an early diagnosis and treatment, which can help keep your bones healthier.

What is osteoporosis?

The word “osteoporosis” literally means “porous bone.”1 Low bone mass and destruction of bone tissue are hallmarks of the condition, leading to higher risk of fractures (broken bones), especially of the hip, spine, and wrist.1

It is estimated that approximately more than 53 million people in the US are living with osteoporosis or are at risk of developing it because of low bone mass.1 Both men and women can have osteoporosis, but it is more common in women.1

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There are no symptoms of osteoporosis; it’s often considered a silent condition because it’s not until you fracture a bone that the osteoporosis might be found. Fractures can occur with minimal trauma or none at all, such when a vertebrae collapses, which is called a compression fracture.

Why does osteoporosis occur?

Bone is living tissue. It is constantly breaking down and rebuilding. Old bone is removed and new bone is added. More bone is added than breaks down from birth up until peak bone mass is achieved, usually in the late 20s.1 After that, breakdown slowly starts to outpace formation of new bone. As bone mass decreases, osteoporosis can occur, leading to weak and porous bones. This increases the risk of fracture.

There are also certain risk factors for osteoporosis. Just because you have a risk factor (or even many), this does not mean you will definitely develop osteoporosis. It means you may be at higher risk. Knowing the risk factors can help you modify your behavior to improve your health and possibly reduce your risk of developing the condition.

Risk factors for osteoporosis can include:1

  • Sex: Women have a higher risk of osteoporosis because of changes associated with menopause.
  • Age: Older people are at higher risk than younger.
  • Ethnicity: white and Asian people are at highest risk.
  • Family history.
  • Lack of vitamin D and calcium intake.
  • Sedentary or inactive lifestyle.
  • Extended bed rest.
  • Cigarette smoking.
  • Excessive alcohol consumption.
  • Steroid use.

Low bone mass has also been seen in people with conditions on the AxSpA spectrum. The prevalence of osteoporosis may include up to 47 percent of people with conditions on the AxSpA spectrum.2 People with AxSpA spectrum conditions may be at higher risk of loss of bone mass because of pro-inflammatory chemicals released in the body, decreased physical activity, or mechanical factors like spine rigidity of bone deformities.2

How is osteoporosis diagnosed and treated?

If osteoporosis is suspected, a bone mineral density (BMD) test may be done. BMD tests can diagnose osteoporosis, help find out your risk of fracture, and measure the response to osteoporosis treatments.1 The most common BMD test is called a dual-energy x-ray absorptiometry, or central DXA test.1 You might hear it called a “DEXA scan.” It is similar to an x-ray but with less radiation. It is noninvasive and painless, and can measure bone density at your hip and spine.

Treatment for osteoporosis should be comprehensive. It should not only treat osteoporosis, but help reduce your risk of fractures. Treatment can include changes to nutrition and diet, exercise (talk with your doctor before starting any exercise regimen to make sure it’s safe), and medication.

Medication for osteoporosis can include:1

  • Bisphosphonates
  • Estrogen or hormone therapy
  • Estrogen agonists/antagonists (also called selective estrogen receptor modulators, or SERMs)
  • Parathyroid hormone (PTH) analog
  • Parathyroid hormone-related protein (PTHrp) analog
  • RANK ligand (RANKL) inhibitor
  • Tissue-selective estrogen complex (TSEC)

Your doctor might also suggest things like using a cane or walker for stability and to reduce your risk of falling and fracture, or making changes to your house to make sure it’s easy to get around and reduce any fall risks.

Treatment can look different for each person, so it’s important to remember that your treatment plan is designed for you. It takes into account both the osteoporosis, as well as your AxSpA spectrum condition. Talk with your doctor about any concerns you have or any questions regarding your treatment.