IBD and Osteoporosis: What You Need to Know About IBD and Bone Health

Written by: CDHF

Updated: July 28th, 2026

Living with inflammatory bowel disease (IBD), such as Crohn’s disease or ulcerative colitis, can affect more than your digestive system. Many people are surprised to learn that IBD can also weaken bones, increasing the risk of osteoporosis. Osteoporosis is a condition where bones become thin, fragile, and more likely to break.^1-4
This article explains how IBD and osteoporosis are connected, who is at risk, how to protect your bone health, and it provides an overview of the treatment options used for osteoporosis.

What Is Osteoporosis?

Osteoporosis is a disease that happens when the body loses bone faster than it can build new bone. Osteoporosis makes bones weaker over time, so they can break more easily. Breaks happen most commonly in the bones in the spine, hip, and wrist.^3,4
Osteoporosis is more common in people with IBD, and it may occur at younger ages than in the general population.^1,2

Close-up drawing of spinal bones showing weakened, porous bone typical of osteoporosis, with a speech bubble that says “Ask me about increased risk” and a small image of Karla, CDHF’s AI expert, in the corner.

How IBD Increases the Risk of Osteoporosis

Long-term inflammation affects bone health: Inflammation because of IBD can weaken bones by slowing down the cells that build new bone and speeding up the cells that break bone down. Long-lasting inflammation in the gut can also release certain proteins, called inflammatory cytokines, that make bone loss even worse.^1,2

Steroid use can thin bones: Steroids, which are sometimes used during IBD flare-ups, can make it harder for the body to absorb calcium and can slow down the cells that build bone. Using steroids for a long time, or many times, may raise the risk of osteoporosis.^1,2,4

Poor absorption of vitamin D: Along with gut inflammation, diarrhea, a common symptom of IBD, can make it harder for the body to absorb vitamin D. Your bones need vitamin D to absorb calcium and stay strong.^1,2,5

Lower body weight: Many people with IBD struggle to maintain a healthy body weight, especially during flares. Low body weight is a known risk factor for bone loss.^1,2,4

Changes in hormones: IBD and low nutrient levels can impact hormones that regulate bone health, increasing the risk of bone loss.^2,4

Less physical activity: Fatigue, pain, or other IBD symptoms may reduce physical activity, which may weaken bones over time.^2,4

Who Is Most at Risk?

You may have a higher risk of osteoporosis if you:^1,2,4

Have had IBD for many years
Experience frequent or severe flare-ups
Have taken steroid medications for long periods
Are underweight
Smoke or drink alcohol regularly
Are age 50 or older
Have a family history of osteoporosis

How Individuals Living with IBD Can Protect Their Bones

Living with IBD can increase the risk of bone loss and osteoporosis. The good news is that there are things you can do to help protect your bones and support long-term health.

Ask your healthcare provider about a bone density test: A dual-energy X-ray absorptiometry (DXA) scan is a special X-ray that measures bone strength. It is recommended for people who have higher risk of osteoporosis, like those who use steroids or have had IBD for many years.^1,2

Support bone health with calcium and vitamin D: Eat foods that support bone health. Good sources of calcium and vitamin D include dairy products, leafy green vegetables, fish, and fortified juices, milks and grains.

Healthcare providers may check vitamin D levels and recommend supplements if needed.⁴

Get active: Weight-bearing activities, such as walking, dancing, or strength training, can help build and strengthen bones.⁴

Quit smoking and limit alcohol: Smoking and drinking are known to weaken bones.⁴

Stay on top of IBD treatment: Managing inflammation lowers the risk of bone loss and may reduce the need for steroids.⁶

Treatment Options for Osteoporosis

If you are diagnosed with osteoporosis, your healthcare provider may recommend a combination of lifestyle strategies and medications.

Healthy habits that support bone strength: Improving nutrition, staying active, and avoiding smoking and alcohol form the foundation of bone health.⁴

Medications that slow bone breakdown: Certain medications slow how quickly bone is lost. These include denosumab, bisphosphonates, calcitonin, estrogen, and drugs that change how estrogen acts in the body.⁴

Medications that help build new bone: Other treatments help the body form new bone. These include synthetic hormones (like teriparatide) and romosozumab.⁴

Biosimilar/Biologic treatments for osteoporosis: Biosimilar/biologic medications are made from living cells and target specific pathways that influence bone breakdown. They help increase bone density and reduce fracture risk.^7,8

Examples of biosimilar medicines used for osteoporosis treatment include Jubbonti^® and Stoboclo^TM, which are approved biosimilars of the biologic medicine Prolia^® (denosumab). Osnuvo^® is an approved biosimilar of the biologic Forteo^® (teriparatide). Evenity^® (romosozumab) is another approved biologic.^7,9-14*

Apo-teriparatide and teva-teriparatide are generic interchangeable versions of Forteo^®. These generics are manufactured differently than the originator but have the same efficacy and safety.^15-17*

Your healthcare provider will help you determine which medicine is right for you.

*Examples as of December 2025. New medications may be approved by Health Canada.

Biosimilars and Biologics: What Patients Should Know

Biosimilars provide the same clinical benefits as their biologic counterparts and meet strict Canadian standards for quality, safety, and effectiveness.

For many patients, they offer an accessible treatment option for serious bone loss.

A biosimilar medication is a biologic drug that is highly similar to an existing biologic medication (known as the reference biologic drug) that have already been authorized for use and for sale.

Biosimilars have been approved by Health Canada based on a thorough comparison to a reference biologic drug and may enter the market after the reference biologic drugs’ patents and data protection have expired.^7,8

Key Takeaways

People with IBD have a higher risk of osteoporosis due to inflammation, steroid use, nutrient issues, and other factors.^1,2

Bone density testing, good nutrition, and physical activity can help protect bone health in Canadians living with IBD.⁴

Osteoporosis is treatable, and many effective medications, including biologics and biosimilars, are available.^7,8

NEW! Ask Karla!

Karla can help you make sense of how GI conditions can affect your bone health. Ask her about things like inflammation, nutrient absorption, and osteoporosis risk.
Please remember that Karla does not replace the advice of your doctor. Be sure to discuss any concerns or next steps with your healthcare provider.

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This initiative was made possible through a financial support from Sandoz.

References

1. Lima, Carla Andrade, et al. 2025. “Risk factors for osteoporosis in inflammatory bowel disease patients.” World journal of gastrointestinal pathophysiology, 6.4; 210. 2. Kreienbuehl, Andrea, et al. 2024. “Bone health in patients with inflammatory bowel disease.” Swiss medical weekly, 154.6: 3407. 3. Osteoporosis Canada. “What is Osteoporosis?” Available at: https://osteoporosis.ca/what-is-osteoporosis/. Accessed December 2025. 4. National Institute on Aging – National Institute of Health. “Osteoporosis.” Available at: https://www.nia.nih.gov/health/osteoporosis/osteoporosis. Accessed December 2025. 5. Osteoporosis Canada. “Vitamin D.” Available at: https://osteoporosis.ca/vitamin-d/. Accessed December 2025. 6. Chedid, V. G., & Kane, S. V. 2020. “Bone health in patients with inflammatory bowel diseases.” Journal of Clinical Densitometry, 23(2), 182-189. 7. Osteoporosis Canada. “Biosimilars.” Available at: https://osteoporosis.ca/biosimilars/. Accessed December 2025. 8. Government of Canada. “Biosimilar biologic drugs.” Available at: https://www.canada.ca/en/health-canada/services/drugs-health-products/biologics-radiopharmaceuticals-genetic-therapies/biosimilar-biologic-drugs.html. Accessed December 2025. 9. Prolia^® Product Monograph. Amgen Canada Inc. May 6, 2025. 10. Forteo^® Product Monograph. Eli Lilly Canada Inc. August 12, 2021. 11. Evenity^® Product Monograph. Amgen Canada Inc. June 17, 2021. 12. Jubbonti^® Product Monograph. Sandoz Canada Inc. February 16, 2024. 13. Stoboclo^TM Product Monograph. Celltrion Inc. September 17, 2025. 14. Osnuvo^® Product Monograph. AVIR Pharma Inc. March 14, 2022. 15. Teva-teriparatide Product Monograph. Teva Canada Limited. March 6, 2019. 16. Apo-teriparatide Product Monograph. APOTEX Inc. May 1, 2020. 17. Osteoporosis Canada. “Parathyroid hormone analogues (PTH)” Available at: https://osteoporosis.ca/parathyroid-hormone-analogues/. Accessed December 2025.