Understanding the Link Between Asthma and Osteoporosis

Learn how common treatments for asthma may be related to thinning of the bones.

Middle-aged man looking positive and strong while he strengthens his muscles and bones by stretching a resistance band above his head

Medically reviewed in May 2022

Updated on June 1, 2022

Are you one of the approximately 25 million people in the United States with asthma? If you are, you should know that you may also be at increased risk of osteoporosis, a disease that causes the bones to become thin and weak and is responsible for millions of bone fractures each year.

Why are you more likely to develop osteoporosis if you have asthma?

Simply put, prescription anti-inflammatory corticosteroids are the main culprit.

Certain asthma treatments may be to blame
Prescription corticosteroids are drugs commonly taken to help manage asthma. They are either inhaled or taken orally, usually twice a day. They decrease inflammation, which helps prevent asthma attacks and control symptoms like wheezing and difficulty breathing. Because most of these types of medicines take time to work, they are typically not used as fast-relief medicines to treat sudden asthma attacks, though some forms may be used for acute flare-ups.

Your healthcare provider (HCP) may prescribe inhaled corticosteroids if your asthma symptoms occur more than twice weekly, and they can be very effective in controlling those symptoms. Because they’re usually prescribed at the lowest possible dose and the medicine stays mostly in your lungs, osteoporosis is not a huge risk with inhaled corticosteroids.  

Oral corticosteroids, on the other hand, are associated with more of a risk of osteoporosis, as they are more effectively absorbed throughout the body. Oral corticosteroids may be prescribed if you have severe asthma that is not well controlled by other, less potent medications. But they are usually reserved for short-term use to treat an asthma attack.

While oral corticosteroids are very effective at decreasing inflammation, these control medications may also cause the loss of bone density or bone thickness. Over time, bones can become brittle and easy to fracture. These are called fragility fractures, and the most common areas where they occur are in the hip, wrist, and spine. For example, compression fractures of the vertebrae (the bones that form the backbone) can develop, causing back pain and loss of height.

If you must take oral anti-inflammatory corticosteroids, what can you do to prevent osteoporosis?

Up your calcium and vitamin D intake
One way protect your bones is to make sure that you’re getting adequate amounts of calcium and vitamin D each day. For calcium, food is your best source, so concentrate on getting plenty of dairy products along with leafy greens and fortified breakfast cereals.

Vitamin D is found naturally in only a handful of foods, including fatty fish like mackerel, tuna, and salmon. Although it's often added to milk and orange juice, you may need to take supplements to ensure that your dietary needs are met. If you think you may need to take calcium or vitamin D supplements, always check with your HCP before starting one and discuss appropriate dosages.

Keep your lifestyle healthy
There is a known association between cigarette smoking and higher rates of osteoporosis. It's unclear, however, whether cigarettes themselves cause bones to weaken or whether behaviors and attributes common to smokers are the cause. You should also avoid alcohol, or drink it only in moderation, as alcohol can interfere with the absorption of nutrients and affect your bones.

Exercise is also important. Bones that are challenged be pushing against gravity are healthier bones. And while any exercise is good, weight-bearing exercise—exercise that puts stress (the good kind) on your bones—is key. It can increase your bone density and improve your strength and muscle tone. Walking, running, playing tennis, and dancing all are examples of weight-bearing exercise.

Strength training, in which you challenge your muscles to grow stronger using barbells, weight machines, body weight movements, or resistance bands, is crucial, too. Swimming, while a popular activity for people with asthma, is not a weight-bearing exercise and will not do much for bone density, however beneficial it may be for the cardiovascular system.

Finally, you should also work on improving your balance to minimize your risk of falling (which can lead to fractures). Exercises that may help improve balance include yoga and tai chi.

Get a bone scan
To find out how your bones are holding up, ask your HCP about whether it makes sense to get a baseline DEXA (dual energy X-ray absorptiometry) bone-density scan. This test will likely be covered by insurance but check with your insurance provider beforehand.

This test is particularly worth considering for postmenopausal women, who may be at increased risk for osteoporosis. Knowing if you already have osteoporosis, or if you’re close to developing it, can help guide your asthma treatment choices.

How often you may need to get a bone scan will depend on your individual situation, such as your age, sex, whether you take oral corticosteroids, and whether your initial DEXA scan shows bone thinning. Check with your HCP since recommendations are subject to change.

Consider different asthma therapies
If you're currently taking oral corticosteroids, ask your HCP about the full range of options. Available treatments include:

  • Monoclonal antibody therapy, in which a substance binds to a specific protein in the body to block the inflammatory reaction
  • Inhaled long-acting bronchodilators, which control asthma symptoms and prevent attacks by keeping the airways open for about 12 hours
  • Leukotriene modifiers and allergy shots if you have allergic asthma

With the right mix of treatments and lifestyle approaches, you can effectively manage your asthma and reduce your risk of osteoporosis.

Article sources open article sources

Centers for Disease Control and Prevention. Asthma. Page last reviewed March 30, 2021.
Kumarathas I, Harsløf T, Andersen CU, et al. The risk of osteoporosis in patients with asthma. Eur Clin Respir J. 2020;7(1):1763612. Published 2020 May 19.
Johnell O, Kanis JA. An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int. 2006;17(12):1726-1733.
Fanta CH, Barrett NA. An overview of asthma management. UpToDate. Last updated April 28, 2022.
Rosen HN. Clinical manifestations, diagnosis, and evaluation of osteoporosis in postmenopausal women. UpToDate. Last updated April 27, 2022.
Centers for Disease Control and Prevention. Osteoporosis. Last updated May 18, 2020.
Lewiecki EM. Prevention of osteoporosis. Last updated January 25, 2021.
National Institutes of Health. Calcium. Last updated November 17, 2021.
National Institutes of Health. Vitamin D. Last updated March 22, 2021.
US Preventive Services Task Force. Osteoporosis to prevent fractures: screening. June 26, 2018. Accessed May 11, 2022
Fistarol M, Rezende CR, Figueiredo Campos AL, et al. Time since menopause, but not age, is associated with increased risk of osteoporosis. Climacteric. 2019 Oct;22(5):523-526.

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