Bone Treatments with Lupus

Reviewed by: HU Medical Review Board | Last reviewed: June 2023

If you have lupus, taking care of your bone health will be a priority. That’s because 90 percent of people with lupus are women, and women are already at a higher risk of developing osteoporosis.1

Osteoporosis is a condition that causes the bones to become less strong and more likely to break (fracture). Fractures from osteoporosis can be painful and impact the quality of life. The Lupus Foundation of America estimates that women with lupus are five times more likely to experience a fracture due to osteoporosis.2

Other risk factors for developing osteoporosis include:1

  • Family history of osteoporosis
  • Early menopause or irregular menstrual periods
  • Small frame or thinness
  • Long-term use of steroids
  • Lack of physical activity
  • Smoking
  • Drinking too much alcohol
  • Low calcium and vitamin D intake

Medicines for osteoporosis

Several drugs exist to help prevent or treat osteoporosis. Bisphosphonates are usually the first drug that your doctor will recommend. Bisphosphonates suppress osteoclasts, a type of cell that breaks down bone, which helps bone mass increase. These pills are generally well-tolerated but work best if there is enough calcium and vitamin D in the diet before and during treatment.3-4

The most common side effects of bisphosphonates include heartburn, nausea, indigestion, stomach pain, and gas. Rare severe side effects are usually associated with large, intravenous doses or long-term use, and include fever, pain, very low calcium levels, atrial fibrillation, eye inflammation, and deterioration of the jawbone.4

Other medications prescribed for osteoporosis are denosumab, calcitonin, and hormone medications such as various estrogens, estrogen-like medicines, birth control pills, teriparatide, abaloparatide, and romosozumab.1,6

Nutrition for osteoporosis

Calcium and vitamin D are necessary nutrients to build and maintain healthy bones. Calcium can be found in dairy products; dark green leafy vegetables like spinach; and calcium-fortified beverages like some brands of orange juice. The National Osteoporosis Foundation recommends 1,000 mg per day of calcium for both men and women younger than 50 and 1,200 mg per day for those over 50.4

Vitamin D is found in egg yolks, saltwater fish, and liver. Exposure to sunlight causes the human body to generate vitamin D, but since people with lupus generally avoid sunlight, supplements are common. The National Osteoporosis Foundation recommends 800 to 1,000 IU per day of vitamin D for men and women over 50. Women with lupus who show signs of osteoporosis at younger ages will likely need to supplement their diet like older people.4

Weight-bearing exercise for osteoporosis

Bones, like muscles, are living tissue that gets stronger with use. That is why weight-bearing and resistance exercises help combat bone loss. Weight-bearing means you are working against gravity. Walking outside or on a treadmill, climbing stairs, tennis, and dancing are examples of exercises that help build bones.

Resistance exercises build muscle, which supports your bones. Examples of muscle-strengthening exercises include lifting weights, using elastic exercise bands, and any activity where you lift your own body weight (push-ups and pull-ups).5

Before beginning any new forms of exercise, it is important to check with your doctor. Certain exercises, such as yoga and pilates, may not be safe for those with osteoporosis.

The good news is that by combining nutrition, exercise, and medicine you can build your bone health and reduce your chances of fractures due to osteoporosis.

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