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:

• Certain Bifidobacteria strains have been shown to reduce inflammatory markers in patients with psoriasis   

• Go outside! Phototherapy (i.e., UV exposure) is a beneficial option for psoriatic conditions, as UVB phototherapy has been shown to help clear psoriasis 

• Curcuminoids (such as those derived from turmeric), N-acetyl-glucosamine, and Andrographis paniculata have been shown to possess anti-inflammatory and immunomodulatory properties that may support healthy inflammatory responses in chronic skin conditions

• Remove inflammatory foods! Adopting an anti-inflammatory and low-glycemic diet — by avoiding gluten, dairy, alcohol, refined sugar, and other hyper-processed “junk” foods —may be the first step in helping reduce psoriatic flares, inflammatory cytokines, and free radicals, and may help to support overall bone health

• Manage your blood sugar! Research shows hyperinsulinemia may be one of the culprits behind inflammatory skin conditions, including psoriasis 

• Decrease overall stress! Lowering cortisol levels may help support a healthy inflammatory response

• Berberine may be a helpful tool for preventing bone loss, especially for menopausal and postmenopausal women

• Stay active! Increasing mobility, regular exercise, weight-bearing activity, and resistance training may decrease bone resorption and actually help increase bone formation or remodeling

• As always, vitamin D and accessory nutrients, such as vitamin K2, magnesium, calcium, and other trace minerals, are key players in supporting bone density and in proper calcium trafficking, and in helping to reduce fall-related injuries and fractures 

• Consume adequate protein to maintain muscle mass, ensure proper calcium utilization, and maintain bone health; older individuals may require more protein than the current recommended daily allowance

• Eat more dark leafy greens! Kale, swiss chard, turnip greens, collard greens, and spinach are great sources of calcium, magnesium, and vitamin K1

By Caitlin Higgins, MS, CNS, LDN