Inflammatory changes due to psoriasis may lead to a higher risk of bone diseases, such as osteoporosis. Lifestyle changes, such as increasing vitamin D exposure and eating more calcium-rich foods, may help lower this risk.

Psoriasis is a chronic, inflammatory skin condition caused by elevated immune activity in the skin. These immune processes are normally aimed at fighting off foreign invaders — such as bacteria, viruses, or fungi — and repairing damage to the skin.

However, prolonged inflammation and immune activation can instead harm the skin itself, leading to the painful, itchy, skin changes that occur with psoriasis.

In many people, the inflammatory changes that drive the development of psoriasis are not localized to the skin alone. Other tissues and organ systems may be affected because of psoriasis, including the skeletal system.

As a result, people with psoriasis may be at increased risk for developing bone diseases, such as osteoporosis.

Osteoporosis is a bone disease that develops when bone mineral density and bone mass decrease, or when the structure and strength of bone changes. This can increase the likelihood of fractures.

This article explores the link between psoriasis and osteoporosis, including steps that can be taken to protect bone health with this condition.

A 2022 literature review looked at several studies that have examined the link between psoriasis and bone disease across various populations. These studies suggest that there is an increased risk of osteoporosis in people who have had chronic psoriasis for a long time and have other lifestyle and genetic factors.

Per the specific findings from different studies in the review referenced above, an estimated 3–18% of people with psoriasis develop osteoporosis. Additionally, one study suggests that up to two-thirds of people experience osteopenia, a less severe form of bone loss and a potential precursor to osteoporosis.

According to another 2022 research review, people with psoriatic disease — including psoriasis and psoriatic arthritis, an inflammatory joint condition that commonly develops among people with psoriasis — may be more likely to develop osteoporosis or osteopenia compared with those without psoriatic disease.

However, there is not enough evidence to definitively suggest a link between psoriasis and osteoporosis or osteopenia. More research is needed.

Psoriasis is an inflammatory condition characterized by overactivation of the immune system. Many of the immune factors that have been linked to psoriasis have also been found to be involved in bone remodeling.

The inflammatory mediators may therefore affect the delicate balance between bone formation (in which new bone is created) and bone resorption (in which old bone is broken down).

Bone health in psoriasis may also be affected by disruption of vitamin D synthesis. Vitamin D — which helps support calcium metabolism and, therefore, bone health — is produced in skin cells.

This process may become dysregulated in psoriatic skin cells, which could lead to reduced levels of vitamin D and, as a result, an imbalance in the calcium-phosphate ratio. This can ultimately lead to bone mineralization disorders, such as osteoporosis.

Vitamin D synthesis is dependent on sunlight as well. Covering up psoriatic skin for protective or cosmetic reasons may also result in lower levels of vitamin D production and affect bone health.

The role of psoriasis treatment

Corticosteroids are immune-modulating agents often used to reduce inflammation in people with inflammatory conditions such as psoriasis.

However, one of the possible side effects of long-term or high dose steroid use is changes to bone remodeling, which may increase the likelihood of osteoporosis.

According to recent research involving more than 723,000 adults from Denmark who were treated with corticosteroids, the likelihood of developing osteoporosis increased with longer durations and higher doses of topical corticosteroid use, including those commonly used to treat psoriasis.

Increased corticosteroid use in this study was also found to increase the likelihood of major osteoporotic fracture, which included fractures of the hip, upper arm, forearm, or spine.

The effects of other psoriasis therapies on bone health and risk of osteoporosis have not been well studied.

Several steps can be taken to protect bone health with psoriasis, including lifestyle and treatment options.

To improve bone health, the National Institute on Aging (NIA) recommends:

  • increasing physical activity
  • quitting or avoiding smoking
  • limiting alcohol consumption
  • eating a bone-healthy diet rich in calcium, vitamin D, and protein

Physical activity should be aimed at building and strengthening bones. Weight-bearing exercises are best for this, which may include:

  • walking, hiking, or jogging
  • climbing stairs
  • tennis
  • dance

Exercises that take place outside can also help increase sun exposure, which can support vitamin D production.

Calcium-rich foods such as low fat dairy, leafy greens, and whole grains can also help provide the nutrients needed for bone health. 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.

Additionally, while some psoriasis therapies may increase the likelihood of bone complications, research suggests that more targeted options may protect bone health.

According to a 2019 study involving people with psoriatic arthritis, those who were treated with a biologic disease-modifying anti-rheumatic drug (bDMARD) were more likely to have high bone mineral density and improved bone health compared with those who received other forms of psoriasis therapy.

A dermatologist or rheumatologist can help determine if a change of medication is needed to help protect bone health during psoriasis treatment.

For people who have already been diagnosed with osteoporosis, medications may be added to the lifestyle steps described above to help support bone health.

Extra steps can also be taken to prevent falls and fractures, such as using a cane or walker or installing grab bars in the home.

Osteoporosis is typically considered a “silent disease.” Many people do not know they have it until they break a bone. Since not all bone fractures are obvious, it is important that people discuss any chronic bone pain they have with their doctor.

The Centers for Disease Control and Prevention (CDC) recommends using a bone density scan when screening for osteoporosis in women 65 years of age and older, as well as postmenopausal women who are younger than 65 years but at increased risk of osteoporosis. This may include some people with psoriasis.

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.

People with psoriasis may be at increased risk of developing osteoporosis, a bone disease that increases their chances of bone fractures.

Low bone density in psoriasis may be the result of a variety of factors, including chronic inflammation, prolonged or high dose corticosteroid use, and reduced vitamin D production.

Osteoporosis is treatable. There are steps that people can take to prevent or reverse bone loss before injury occurs.

People with psoriasis who may be more likely to develop osteoporosis based on their age, medication use, or lifestyle can talk with their healthcare team about steps that can be taken to protect their bone health.