Ankylosing spondylitis: Am I at risk of osteoporosis?

By Mayo Clinic Staff
Feb. 22, 2023

Does having ankylosing spondylitis increase my risk of osteoporosis?

Yes, ankylosing spondylitis does increase your risk of osteoporosis — a condition that causes bones to thin and weaken as they become more porous inside.

Decreased bone mineral density is a common complication of ankylosing spondylitis. This is especially true for those who've had the condition for a long time. But some studies suggest it can also affect those who've been diagnosed with ankylosing spondylitis for a shorter time — less than 10 years.

Although you can't change that you have ankylosing spondylitis, you can take steps to help reduce your risk of osteoporosis.

To help keep your bones strong:

  • Exercise 30 to 60 minutes most days.
  • Eat a balanced diet of nutritious foods, including adequate calcium and vitamin D.
  • Don't smoke cigarettes or use other tobacco products.
  • Limit the amount of caffeine and alcohol in your diet.
  • Maintain a healthy weight.
  • Maintain a healthy posture.
  • Take steps to prevent falls, such as wearing low-heeled shoes.
  • Have regular physical exams.

Studies also suggest that tumor necrosis factor (TNF) blockers — sometimes used to treat ankylosing spondylitis — may help maintain or increase bone density in the spine and hip. However, treatment with these medications doesn't appear to decrease vertebral fractures. More research is needed.

  1. Yu DT, et al. Treatment of axial spondyloarthritis (ankylosing spondylitis and nonradiographic axial spondyloarthritis) in adults. https://www.uptodate.com/contents/search. Accessed May 2, 2019.
  2. van der Weijden MA, et al. High prevalence of low bone mineral density in patients within 10 years of onset of ankylosing spondylitis: A systematic review. Clinical Rheumatology. 2012;31:1529.
  3. Haroon NN, et al. Effect of TNF-alpha inhibitor treatment on bone mineral density in patients with ankylosing spondylitis: A systematic review and meta-analysis. Seminars in Arthritis and Rheumatism. 2014;44:155.
  4. Barbara Woodward Lips Patient Education Center. Healthy bones for life: Preventing osteoporosis. Rochester, Minn.: Mayo Foundation for Medical Education and Research; 2017.
  5. Ashany D, et al. The effect of TNF inhibition on bone density and fracture risk and of IL17 inhibition on radiographic progression and bone density in patients with axial spondyloarthritis: A systematic literature review. Current Rheumatology Report. 2019;21:20.
  6. Beek KJ, et al. Long-term treatment with TNF-alpha inhibitors improves bone mineral density but not vertebral fracture progression in ankylosing spondylitis. Journal of Bone Mineral Research. In press. Accessed May 14, 2019.

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