Osteoporosis: is it An Autoimmune Disease?

Osteoporosis is a condition that affects your bone density. It often occurs in:

• women after menopause
• people of all genders as they age
• people who have other health conditions like autoimmune diseases

It is a “silent” condition that can occur for many years before you notice symptoms, like bone fractures or shrinking height.

Osteoporosis is not an autoimmune disease. But research suggests a malfunctioning immune system may cause osteoporosis. Scientists are studying this link between changes in your bones and your immune system.

Diagnosing both osteoporosis and any underlying autoimmune disease is important to managing the conditions and reducing problematic symptoms later.

Osteoporosis and the immune system

Some developing research focuses on how osteoporosis is influenced by the immune system and if it’s related to autoimmune diseases. The immune system and bone system are linked. They share certain molecules and regulatory mechanisms. Researchers want to find out more about how this link may cause bone loss.

Your immune system exists to fight outside germs that make you sick, but it can malfunction. Sometimes, your immune system creates proteins called autoantibodies that attack healthy cells in your body. This is called autoimmune disease.

These autoantibodies can affect your entire body, including your organs, joints, and skin. This can result in painful and debilitating symptoms.

A 2017 review suggests that autoantibodies, as well as chronic inflammation, can contribute to bone loss. Immune cells affect the remodeling of bones, so changes in your immune system can affect the density of your bones.

More studies looking into this link could help doctors to better understand osteoporosis and find more effective treatments for it.

What causes osteoporosis?

Doctors classify osteoporosis as either primary or secondary, depending on what causes it.

Primary osteoporosis

Most people with osteoporosis have primary osteoporosis. According to a 2017 review, 80 percent of women and 60 percent of men with osteoporosis have this type.

One or more of these factors can lead to primary osteoporosis:

• aging
• menopause
• family history
• lifestyle factors like diet and exercise

The Office on Women’s Health says that women develop primary osteoporosis more than men. It often occurs after menopause because of a change in estrogen levels. Estrogen helps keep your bones strong.

Men, too, can experience primary osteoporosis as a result of changes in testosterone and estrogen levels.

Secondary osteoporosis

Secondary osteoporosis is when the disease is caused by other health conditions. These include autoimmune disease and connective tissue disorders. It may also occur as a side effect of some medications, such as steroids used to treat autoimmune diseases. The medical field is currently expanding its research to understand how osteoporosis and autoimmune diseases may be linked.

Osteoporosis makes your bones more brittle, and they may fracture easily. You may experience a fracture in your hips, spine, or another bone. Fractures can occur years after the onset of the condition, so it’s important to visit a doctor to determine whether you may be susceptible to bone loss. Talk with your doctor if you fall into any of the risk categories for primary or secondary osteoporosis.

What autoimmune diseases are connected to osteoporosis?

A 2017 review showed that some autoimmune diseases can affect your bone integrity and lead to osteoporosis. These include:

• rheumatoid arthritis
• ankylosing spondylitis
• psoriatic arthritis
• inflammatory bowel disease
• systemic lupus erythematosus

Conditions related to your immune system, like asthma, thyroid disease, and celiac disease, also increase your risk of osteoporosis.

Diagnosing osteoporosis with autoimmune disease

Your doctor can conduct tests to determine whether you have osteoporosis along with an autoimmune disease. There is not one single test to diagnose both conditions, so your diagnosis will involve a few different methods.

Traditional tests for osteoporosis look at bone mineral density. This is an imaging test completed while you lie flat on a table. Your doctor will be able to determine your entire body’s bone density. They will also be able to determine the bone density in various parts of your body where you might be more vulnerable to fractures, like your back and hips.

Determining if you also have an autoimmune disease will require laboratory tests. One type of blood test that looks for a variety of these conditions is the antinuclear antibody (ANA) test. Other tests may look for certain proteins and inflammation in your blood or urine.

Your doctor may also order an X-ray or other imaging studies to help make a diagnosis. These tests can help detect autoimmune diseases like ankylosing spondylitis.

Elevated levels in laboratory tests might mean that your immune system is not working properly. Your doctor can use this information, along with your bone density scan, family history, and a physical examination, to determine a treatment plan for your symptoms.

The bottom line

Osteoporosis is not considered an autoimmune disease. But new research suggests that the bone condition could be linked to the immune system in ways never considered before.

Some autoimmune diseases increase your risk of secondary osteoporosis. Talk with your doctor if you suspect you have either condition. Early treatment can prevent worsening symptoms that affect your daily life.

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