If you have ulcerative colitis (US), a form of inflammatory bowel disease (IBD), chances are, your main priority is controlling your symptoms so you can live a normal, healthy life — and rightfully so.
But if you’ve been treating your condition with medications called glucocorticoids, such as prednisone or cortisone, you may be susceptible to a common UC-related health complication: bone density loss. (While glucocorticoids are a huge risk factor, colitis alone and its associated inflammation makes you prone to losing bone mass.) And as your bones become less dense, you may develop osteopenia (weakening of the bones) or osteoporosis, a serious condition that makes your weakened bones more likely to fracture.
According to the U.S. Department of Health and Human Services, more than 53 million Americans have either already been diagnosed with osteoporosis or have low bone mass. In general, post-menopausal women are at highest risk for the condition, but both women and men, especially men over the age of 50 with UC, need to be mindful, as an estimated 30 to 60 percent of people with IBD have lower-than-average bone density, according to the Crohn’s & Colitis Foundation.
There are several reasons for this increased risk. The first is that while glucocorticoid therapy reduces the inflammation associated with IBD, it can also weaken bones. Inflammation and low testosterone in men also increases the risk.
“Low physical activity also plays a role,” says Madalina Butnariu, MD, an assistant professor in the division of gastroenterology, hepatology, and nutrition at the Ohio State University Wexner Medical Center in Columbus.
If you have UC, here’s what you need to know about osteoporosis and what you can do to prevent it.
What Is Osteoporosis?
Known as a “silent” condition, because it often goes undetected for many years, osteoporosis causes bones to become less dense and more likely to fracture. Bone fractures resulting from osteoporosis can be extremely painful and cause disability.
Unfortunately, many people with osteoporosis aren’t diagnosed until after they’ve suffered one of these debilitating fractures, according to the Centers for Disease Control and Prevention (CDC). Part of the reason is that those with the condition may not experience any symptoms, other than some back pain or a change in posture, which they may associate with advancing age.
Most osteoporosis-related fractures occur in the spine and hips, which makes it difficult to walk and move around, so getting screened for bone loss (bone density testing) and taking preventive measures to halt it are extremely important.
8 Tips for Preventing Osteoporosis in UC
If you know you’re at risk for bone loss because of your UC treatment, here are steps you can take to prevent it.
- Undergo routine bone density testing. If you have UC and take a glucocorticoid, it’s important to have your bone density checked regularly, says Dr. Butnariu. If you’re not currently getting routine tests, talk to your doctor. “We perform what’s called a DEXA scan to assess bone density in people at risk of bone loss, especially those with a history of long-term steroid use,” says Butnariu. “If the DEXA scan is consistent with osteoporosis, we refer them to an appropriate specialist for treatment.”
- Treat your osteoporosis if you already have it. Once you know you have osteoporosis, you should get appropriate therapy to reduce your risk of painful fractures, says Butnariu. Part of that therapy may include medications designed to enhance bone health, such as once-a-week bisphosphonate drugs approved for steroid-induced osteoporosis, according to a research paper published by StatPearls.
- Take calcium. The Crohn’s & Colitis Foundation recommends a diet rich in calcium, a mineral essential for bone building, and daily 1,500 milligram (mg) calcium supplements. According to the Cleveland Clinic, the best sources of calcium are dairy products, such as milk, yogurt, and cheese. It can also be found in almond or soy milk, dark green leafy vegetables, dried peas and beans, fish with bones, and calcium-fortified juices and cereals. Extra calcium may be particularly helpful during a UC flare, when absorption of the mineral often declines.
- Make sure you’re getting enough vitamin D. Vitamin D is essential for your body to absorb calcium, the Crohn’s & Colitis Foundation notes. Sunlight works to synthesize vitamin D in your skin, so if you don’t get adequate natural sunlight, the Crohn’s & Colitis Foundation recommends supplementing with foods, such as fortified milk, fish oil, or liver, or taking 800 international units (IU) of supplemental vitamin D daily, which can be found in most over-the-counter multivitamins. “I typically recommend all my patients with UC take a multivitamin, and in those patients with low vitamin D levels, we supplement to achieve a goal of vitamin D levels in blood above 30 nanograms per milliliter (ng/mL),” says Jami Kinnucan, MD, an IBD specialist and a senior associate consultant in gastroenterology and hepatology at the Mayo Clinic in Jacksonville, Florida. “We check this through regular blood tests. Typically you can take supplements of calcium with vitamin D in addition to vitamin D alone.”
- Consider changing your medication therapy. According to the Crohn’s & Colitis Foundation, steroid use is a risk factor for osteoporosis, so it is ideal to consider steroid-sparing treatments for UC. Joseph Feuerstein, MD, an associate clinical chief at the center for inflammatory bowel disease at Beth Israel Deaconess Medical Center in Boston, says he recommends steroid-sparing drugs like immunomodulators or biologics. “Corticosteroids have long been associated with bone loss that can be persistent and long-standing,” he explains. “Once someone is on a high dose of corticosteroid for more than four to six weeks, there is a risk of osteoporosis. Steroids should be used sparingly to treat UC and avoided unless absolutely necessary.”
- Limit alcohol consumption. Excessive alcohol is a risk factor for osteoporosis. It also isn’t ideal for managing your UC. Although there are no hard-and-fast rules for “healthy” alcohol consumption, the 2020–2025 Dietary Guidelines for Americans defines moderate alcohol use for healthy adults as up to one drink a day for women and up to two drinks a day for men.
- Quit smoking. Like excessive alcohol consumption, smoking is a risk factor for osteoporosis and bad for your overall health. If you quit smoking, you can reduce your risk of bone density loss and other health complications.
- Exercise regularly. According to Dr. Feuerstein, weight-bearing exercises help build bones and maintain their strength. If you have broken a bone due to osteoporosis or are at risk of breaking a bone, you may need to avoid high-impact exercises. If you’re well enough to exercise, the Bone Health and Osteoporosis Foundation (BHOF) recommends bone-building exercises, such as dancing, aerobics, hiking, jogging, running, or tennis. Low-impact exercises such as using an elliptical machine or walking fast on a treadmill can also help keep bones strong and are a safe alternative if you can’t do high-impact exercises, BHOF says.
Additional reporting by Ashley Welch.
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