How does lupus affect my bones?
Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis can result in significant pain and disability. Osteoporosis is a major health threat for an estimated 44 million Americans, 68 percent of whom are women.
Risk factors for developing osteoporosis include:
- having a family history of the disease
- for women, being postmenopausal, having an early menopause, or not having menstrual periods (amenorrhea)
- using certain medications, such as corticosteroids (steroids, glucocorticoids)
- not getting enough calcium
- not getting enough physical activity
- drinking too much alcohol.
Osteoporosis is a silent disease that can often be prevented. However, if undetected, it can progress for many years without symptoms until a fracture occurs.
The Lupus-Osteoporosis Link
Studies have found an increase in bone loss and fracture in individuals with lupus. In fact, women with lupus may be nearly five times more likely to experience a fracture from osteoporosis. Individuals with lupus are at increased risk for osteoporosis for many reasons.
To begin with, the steroid medications often prescribed to treat lupus can trigger significant bone loss.
In addition, pain and fatigue caused by the disease can result in inactivity, further increasing osteoporosis risk.
Studies also show that bone loss in lupus may occur as a direct result of the disease. Of concern is the fact that 90 percent of the individuals affected with lupus are women, a group already at increased osteoporosis risk.
Osteoporosis Management Strategies
Strategies for the prevention and treatment of osteoporosis in people with lupus are not significantly different from the strategies for those who do not have the disease.
A diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include dairy products, dark green, leafy vegetables, and calcium-fortified foods and beverages. Also, supplements can help ensure that the calcium requirement is met each day. Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. While many people are able to obtain enough vitamin D naturally, excessive sun exposure can trigger flares in some people with lupus. These individuals may require vitamin D supplements in order to ensure an adequate daily intake. People with lupus are encouraged to talk to their physician about having their vitamin D level checked.
Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercise for bones is weight-bearing exercise that forces the body to work against gravity. Some examples include walking, climbing stairs, weight-lifting, and dancing.
Exercising can be challenging for people with lupus who are affected by joint pain and inflammation, muscle pain, and fatigue. However, regular exercises can help prevent bone loss, as well as providing many other health benefits.
Smoking is bad for bones as well as the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol can also negatively affect bone health. Those who drink heavily are more prone to bone loss and fracture, both because of poor nutrition and an increased risk of falling.
Bone density test
Specialized tests known as bone mineral density (BMD) tests measure bone density at various sites of the body. These tests can detect osteoporosis before a fracture occurs and can help to predict the chances of future fractures. People with lupus, particularly those taking steroids for two or more months, should talk to their doctors about having regular bone density tests.
Like lupus, osteoporosis is a disease with no cure. However, there are medications available to prevent and treat osteoporosis.
The following are approved by the Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis in postmenopausal women:
- alendronate, Fosamax® (also approved for use in men)
- risedronate, Actonel®
- ibandronate, Boniva®
- raloxifene, Evista®
- calcitonin, Miacalcin®
- teriparatide, Forteo®
- estrogen/hormone therapy
Alendronate also has been approved to treat glucocorticoid-induced osteoporosis, and risedronate has been approved to treat and prevent it.
Medically reviewed on July 25, 2013