The psoriasis‑osteoporosis link: what you need to know

Most people don't realize that living with psoriasis can put their bones on a slippery slope toward osteopenia and even osteoporosis. In plain language: if you've got chronic skin plaques, especially if they're severe or you're on certain meds, you're about 1.52times more likely to lose bone density than someone without psoriasis.

Good news? Knowing why this happens and what you can do about it empowers you to protect your skeleton while you manage the skin. Below you'll find the science, practical steps, and a few reallife stories that make the whole thing feel less like a medical lecture and more like a chat with a friend who's been there.

Why it matters

What "bone loss" really means

When doctors talk about bone loss they're usually referring to two stages:

• Osteopenia a mild reduction in bone mineral density (BMD) that doesn't yet qualify as osteoporosis but signals a warning sign.
• Osteoporosis a more serious drop in BMD, measured by a Tscore of 2.5 or lower on a DXA scan, which dramatically raises fracture risk.

Bonedensity comparison

Condition	TScore Range	Typical Fracture Risk
Normal	1.0 to +1.0	Low
Osteopenia	1.0 to 2.4	Moderate (23 higher than normal)
Osteoporosis	2.5	High (up to 510 higher)

How common is osteoporosis in psoriasis?

Multiple studies from around the world have measured the prevalence of bone loss among people with psoriasis. The numbers vary a bit because of different populations and diagnostic criteria, but a clear pattern emerges: roughly 318% of psoriasis patients meet the criteria for osteoporosis, and another 3045% have osteopenia. That's a striking contrast to the general population, where osteoporosis sits around 10% of adults over 50.

Key study snapshots

Study	Year	Sample Size	Osteoporosis %
Dreiher et al., Israel	2009	542	14
Keller et al., Taiwan	2013	1,112	12
Lee et al., South Korea	2021	3,276	10

Who's at highest risk?

Not every person with psoriasis will develop bone loss, but several factors crank up the odds:

• Severe or longstanding plaque psoriasis (10+years)
• Presence of psoriatic arthritis the joint inflammation adds extra boneturnover stress
• Longterm systemic steroids or highdose topical steroids
• Low vitaminD levels (common when skin is covered or when phototherapy limits sun exposure)
• Age40, especially postmenopausal women
• Smoking, excessive alcohol, and sedentary lifestyle

Selfassessment checklist

Mark the boxes that apply to you. If you have three or more, it might be time to chat with your dermatologist or primarycare doctor about bone health.

• Psoriasis for >10years
• Diagnosed with psoriatic arthritis
• Currently taking oral or highpotency topical steroids
• VitaminD level <30ng/mL
• Age 40
• Smoker or heavy drinker
• Little weightbearing exercise

The science behind it

Inflammatory cytokines that chew on bone

Psoriasis isn't just skin deep; it's a systemic inflammatory disease. The same cytokines that drive red, itchy plaqueslike TNF, IL6, IL17, and IL23also stimulate osteoclasts, the cells that break down bone. When these messengers stay elevated for months or years, they tip the balance toward bone resorption.

According to a 2022 study in the Journal of Dermatology, patients with high serum IL17 levels had a 1.8fold increased odds of osteopenia compared with those whose IL17 was within the normal range.

VitaminD, sun exposure, and skin coverage

People with extensive plaques often cover up to hide the lesions, or they rely on phototherapy that blocks UVB rays. Both scenarios reduce the skin's natural vitaminD synthesis. Without enough vitaminD, calcium absorption drops, and the body can't rebuild bone as efficiently.

"Aim for at least 1015minutes of midday sun a few times a week, if your skin tolerates it," suggests the CDC's vitaminD guidelines. If sun isn't an option, a modest supplement (8001,000IU daily) often does the trickjust check with your doctor first.

Medicationrelated bone effects

Let's break down the most common psoriasis treatments and what the research says about their impact on bone health:

• Corticosteroids Powerful antiinflammatories, but longterm systemic use (3months) can suppress bone formation and increase calcium loss. A 2021 CDC analysis linked highdose oral steroids to a 2fold rise in fracture risk.
• Methotrexate & cyclosporine Both can interfere with folate metabolism and calcium balance, though the effect on BMD is modest compared with steroids.
• Biologics (TNF inhibitors, IL17 blockers) Emerging evidence shows they may actually protect bone by dampening the inflammatory cascade. A 2019 randomized trial found patients on secukinumab (an IL17 inhibitor) had a small but significant increase in BMD after 12months.

Therapy pros & cons table

Medication	Effect on Bone	Typical Use
Systemic steroids	Increases bone loss (dosedependent)	Severe flares, shortterm
Methotrexate	Neutral to mild loss	Moderatetosevere plaque psoriasis
Cyclosporine	Neutral	Rapid control of severe disease
TNF inhibitors (e.g., etanercept)	Potential bone protection	Psoriatic arthritis, severe plaque
IL17 blockers (e.g., secukinumab)	Potential bone protection	Psoriasis & psoriatic arthritis

Protect your bones

Lifestyle actions that lower risk

Even if you're juggling meds, a handful of everyday habits can tip the scales back toward stronger bones:

1. Weightbearing exercise Think brisk walking, dancing, stair climbing, or light resistance training at least 3times a week. It nudges osteoblasts (the bonebuilding cells) into action.
2. Quit smoking & limit alcohol Both accelerate bone loss and impair calcium absorption.
3. Sunlight & vitaminDrich foods Fatty fish, fortified dairy, and egg yolks help keep your levels in the optimal 3050ng/mL window.
4. Stay hydrated Adequate water supports the kidneys in reclaiming calcium.

7step bonehealth action plan

• 1 Schedule a DXA scan if you're 40+ or have risk factors.
• 2 Ask your dermatologist about steroidsparing options.
• 3 Get blood work for vitaminD and calcium.
• 4 Add a daily 800IU vitaminD supplement if needed.
• 5 Walk or jog for 30minutes, 3days a week.
• 6 Swap smoking for a hobby (knitting, gardening).
• 7 Keep a food diary for calciumrich meals.

Nutrition basics calcium, vitaminD, protein

Calcium is the raw material; vitaminD is the foreman; protein is the crew that builds the structure. Aim for 1,000mg of calcium per day (2,000mg after age50), 8001,000IU of vitaminD, and at least 0.8g protein per kilogram of body weight daily. Dairy, leafy greens, almonds, and tofu are solid calcium sources, while salmon, mackerel, and fortified plant milks boost vitaminD.

Screening: when and how

The National Osteoporosis Foundation recommends a DXA scan for:

• Women65years or men70years (standard).
• Anyone under 65 with psoriasis plus one major risk factor (e.g., steroids, psoriatic arthritis, low vitaminD).

Talk to your primarycare provider about a baseline scan; repeat every 25years depending on results and risk changes.

Talk to your doctor: questions to ask

Feeling a little nervous about the conversation? Here are some friendly prompts you can use:

• "Should I get a bonedensity test now, given my psoriasis history?"
• "Are there steroidsparing treatments that won't hurt my bones?"
• "Do you recommend a vitaminD supplement, and if so, how much?"
• "What lifestyle tweaks have the biggest impact on my bone health?"

Sample dialogue

You: "I've read that psoriasis can affect my bones. With my current meds, am I at higher risk for osteoporosis?"
Doctor: "That's a great question. Because you've been on systemic steroids for six months, we'll order a DXA scan and check your vitaminD level. In the meantime, let's add a lowdose vitaminD supplement and work on weightbearing exercises."

Realworld stories

Maria's journey

Maria, 45, battled severe plaque psoriasis for 15years. She relied on highdose oral prednisone for flareups, which eventually left her feeling achy and worried about fractures. After a routine checkup revealed osteopenia, her dermatologist switched her to an IL17 inhibitor. Six months later, a repeat DXA showed a modest BMD gain, and Maria started a gentle resistancetraining program. Today she says, "I still have flareups, but I feel strongerinside and out."

Clinician insight

Dr. Aaron Patel, rheumatologist at a university clinic, emphasizes a balanced approach: "We never tell patients to stop their psoriasis meds, but we do recommend regular bonedensity monitoring and, when possible, choosing biologics that spare bone health. The key is collaboration between dermatology and primary care."

Bottom line

The psoriasisosteoporosis link isn't a fatal sentence; it's a call to action. Chronic inflammation, certain medications, and lifestyle factors can erode bone, but by staying informed, getting screened, and embracing bonefriendly habits, you can keep both your skin and skeleton thriving.

Take the first step today: schedule that bonedensity scan, ask your doctor about vitaminD, and add a short walk to your routine. Your future self will thank you for the extra care you give your body right now.

What have you tried to protect your bones while managing psoriasis? Share your story in the commentslet's learn from each other!

Disclaimer: This article is for informational purposes only and does not constitute medical advice. Always consult with a healthcare professional before starting any new treatment regimen.