Osteoporosis is a common complication of UC. It can also be a side effect of UC treatment. There are proactive steps you can take and treatment options that can lower your risk.

Ulcerative colitis (UC) is an inflammatory bowel disease (IBD) that affects the lining of the gut. It’s caused by an overactive immune system, resulting in inflammation and damage to the walls of the large intestine.

Many people with UC experience other complications as a result of this inflammation and intestinal damage, including osteoporosis. Estimates of osteoporosis prevalence vary considerably, but it’s estimated that up to 70% of people with IBD also have osteoporosis, with slightly lower rates observed in people with UC compared to Crohn’s disease (another form of IBD).

Osteoporosis can have important effects on the health and well-being of people with IBD. Studies estimate that people with IBD are around 40% more likely to have a bone fracture compared with their unaffected counterparts.

In this article, we take a look at the link between UC and osteoporosis, including what causes bone loss in UC and how to prevent it.

While UC itself doesn’t directly cause osteoporosis, a variety of factors may contribute to bone loss with the condition, including both the disease itself and treatment.

Steroids are a class of medications commonly used to reduce inflammation in UC. One of the side effects of these drugs, though, is bone loss, which can increase the likelihood of developing osteoporosis.

Research has found that steroid use is one of the leading risk factors for developing osteoporosis in IBD.

Long-standing disease has also been found to be a strong predictor of osteoporosis risk in IBD, which may be due to the chronic inflammation experienced over the course of disease.

Many of the inflammatory molecules that have been linked to IBD and UC have also been found to impact bone metabolism, which could contribute bone loss with these diseases.

Nutritional deficiencies — caused either by dietary changes or lack of sun exposure — can also impact bone health. Low levels of calcium and vitamin D may be especially problematic.

Most people with osteoporosis don’t have any symptoms and may not be aware they have the disease. In many cases, osteoporosis isn’t detected until someone breaks a bone.

Given their increased likelihood of developing osteoporosis, experts suggest that people with UC and IBD take a more proactive approach to screening than is generally recommended.

The American College of Gastroenterology (ACG) recommends that all people taking oral steroids — especially those who have been taking them for longer than 3 consecutive months — should have a bone mineral density (BMD) assessment using bone imaging, repeated periodically to check for changes.

The Crohn’s & Colitis Foundation, on the other hand, recommends screening if any osteoporosis risk factors are present, such as:

  • low body mass index (BMI)
  • prolonged steroid use
  • history of smoking
  • postmenopausal status
  • hypogonadism

According to the Crohn’s & Colitis Foundation recommendations, screening should be repeated at least every 5 years (more often if bone loss is detected).

There are simple steps all people can take to improve their bone health, like:

  • getting active
  • stopping or avoiding smoking
  • limiting alcohol consumption
  • eating a diet rich in vitamin D, calcium, and protein

People with UC may consider additional steps to help prevent osteoporosis. For instance, many foods rich in calcium (like dairy products) can be triggering for some. A registered dietitian, particularly one specializing in IBD, can help ensure you’re getting the nutrients you need for proper bone health while helping to avoid disease flares due to diet.

It’s important to consult a medical professional for guidance when making any changes to diet or medications, including nutritional supplements.

Additionally, people at risk for osteoporosis may want to talk with their gastroenterologist about alternatives to steroids that can help control their symptoms.

Biologic therapies, for example, are another treatment option for UC. In a 2021 study involving more than 112,000 people with UC, rates of both osteoporosis and bone fractures were lower in people who were receiving a biologic therapy than in those taking different kinds of therapies, including steroids.

You may also consider other steroid-sparing treatment options, such as immunomodulators. If a steroid is needed, a locally acting formula (budesonide) may be considered to minimize off-target effects.

If osteoporosis or osteopenia (low BMD) is already present, certain medications can help prevent slow or potentially help reverse bone loss. These include:

  • bisphosphonates
  • calcitonin
  • hormone therapy
  • parathyroid hormone
  • RANKL blockers
  • sclerostin inhibitors

Your IBD care team or primary care doctor can help determine if osteoporosis medication is needed. If your gastroenterologist is not the one prescribing these medications, be sure to let them know at your next visit.

Osteoporosis is a common complication of UC. Its treatment can also lead to bone fractures if not detected and treated promptly.

People with UC can take a variety of steps to protect their bone health, including getting active, eating a bone-healthy diet, and talking with their doctor about medications or supplements.

If you’re concerned about your bone health with UC, your healthcare team can help you determine if imaging is needed to evaluate your bone density and assess your bone health.