Research & Education

Can Psoriasis Increase Risk of Osteoporosis and Fractures?

Psoriasis is defined as “a cutaneous inflammatory disease characterized by chronic and recurrent erythematous scaly plaques” that affects between 0.1% and 2.9% of the world’s population. The occurrence of psoriasis varies by age and geographic location, and it’s more prevalent in regions farther away from the equator. Psoriasis is associated with several comorbidities, including inflammatory arthritis, and with several cardiometabolic disorders, such as obesity, hypertension, diabetes, hepatic steatosis, dyslipidemia, and cardiovascular disease.

Osteoporosis (OP) literally means “porous bone” and is “defined as a generalized disease of the skeleton that is characterized by low bone density and altered microarchitecture leading to increased bone fragility and, as a result, increased risk of fracture.” According to the International Osteoporosis Foundation, OP affects more than 200 million people worldwide, including 30% of all postmenopausal women in the U.S. and Europe. One in three women and one in five men over age 50 experience osteoporotic fractures. Could there be a connection between OP and psoriasis?

Root Cause: Systemic Inflammation

Researchers may have discovered a link between chronic inflammatory diseases and poor bone health. According to an article published in May 2019, those with psoriasis have an increased risk of pathologic fractures and osteoporosis. This research reveals that the pathogenic humoral and cellular mechanisms involved in bone loss have commonalities with the psoriasis pathogenesis. It is well-known in the scientific literature that increases in pro-inflammatory cytokine production may lead to increased bone resorption; specific pro-inflammatory cytokines and molecules (e.g., interleukin [IL]-1, IL-6, IL-11, IL-17, and tumor necrosis factor [TNF]-α) directly affect bones, contributing to bone loss. Similarly, the overproduction of pro-inflammatory cytokines, particularly IL-17A, has been shown to be critical in the pathogenesis of psoriasis. Unfortunately, the current guidelines for managing psoriasis comorbidities do not include addressing bone health yet. TNF and IL-17 are relevant in both conditions and may be “considered possible therapeutic targets to suppress the hyperreactivity of the immune system and restore the equilibrium between bone resorption and formation.”

Nutritional Support for Psoriasis and Osteoporosis

In addition to healthy weight management and routinely monitoring bone resorption rates and markers of inflammation through lab testing, our diet and specific nutritional components may help support bone health and healthy immune responses. Important dietary, supplemental, and lifestyle considerations include:


By Caitlin Higgins, MS, CNS, LDN