Crohn’s Disease and Osteoporosis: How Are They Connected?
Digestive HealthCrohn's Disease

Crohn’s Disease and Osteoporosis: What’s the Connection?

Crohn’s Disease and Osteoporosis: What’s the Connection?
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Published on February 6, 2026
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Loss of bone mineral density can occur for a number of reasons, including genetics, aging, hormone changes, lifestyle habits, and poor nutrition. Another major factor is certain co-occurring chronic medical conditions, and Crohn's disease is on that list.

Osteoporosis, or low bone density with weakened bone structure, develops without noticeable symptoms — most people only discover the condition once they’ve broken a bone.

 Crohn's disease, a form of inflammatory bowel disease (IBD), is a risk factor for osteoporosis, which can occur at any age. Research suggests that osteopenia (low bone density that can progress to osteoporosis) occurs in 22 to 55 percent of those with Crohn’s, while osteoporosis is present in 3 to 6 percent of people with the condition.

"The exact mechanism by which Crohn's disease can cause osteoporosis is not yet known, but it is thought to be due to a combination of the effect of increased inflammation, inadequate nutrition that leads to … deficiencies, and frequent steroid treatments to help control Crohn's symptoms," says Adam Pont, MD, a gastroenterologist with the Medical Offices of Manhattan in New York City.

Here's a look at how each of these factors may play a role, as well as steps to help you prevent and manage bone loss with Crohn's disease.

How Crohn's Disease Can Harm Bone Health

The three major factors that can affect bone health in Crohn's disease are often interconnected, says Dr. Pont. Here's how each of them contribute to lower bone mass.

Chronic Inflammation

Systemic, ongoing inflammation is a hallmark of Crohn's, and it can disrupt the normal bone-remodeling process that helps your bones maintain their density.

Bone creation, repair, and strengthening is controlled by three key cell types:

  • Osteoclasts break down old bone tissue that is no longer needed, releasing the minerals stored in that tissue so it can be used for other functions.
  • Osteoblasts form new bone tissue to replace the old tissue, to remodel or heal any bone that needs to be strengthened as you age or that’s been damaged.
  • Osteocytes are transformed osteoblasts that monitor changes in bone integrity and trigger the activity of osteoblasts and osteoclasts.
This bone remodeling cycle is dynamic and continuous, but inflammation can disrupt the process. That might lead to osteoclasts breaking down bone faster than osteoblasts can replace tissue.

 People with IBD often have elevated concentrations of immune proteins called cytokines, some of which increase the body's inflammatory response. These can sabotage the bone remodeling process.

Malabsorption and Nutrient Deficiencies

Another factor affecting bone health is how well you absorb nutrients, because vitamins and minerals like calcium and vitamin D, among others, are crucial for bone tissue repair and remodeling.

Crohn's is characterized by inflammation and damage throughout the digestive tract, and particularly in the small intestine, which is the main site for nutrient absorption, says Pont. Because of this, vitamin D and calcium may be poorly absorbed, particularly if Crohn's is not well managed by medical treatments, he says.

Steroid Use

To decrease active inflammation in Crohn's, many people with the condition take corticosteroids (also called steroids), anti-inflammatory medications that can resolve symptoms of a flare quickly. But these drugs can be problematic if taken on a long-term basis.

One study found that chronic steroid use — defined as three months or more — roughly doubles the risk of osteoporosis in people with IBD, compared with those who didn’t have chronic steroid exposure.

 A more recent research review suggested that the exact risk of short- or long-term steroid use contributing to osteoporosis in Crohn’s is still unclear.

This is because corticosteroids disrupt the formation of new bone tissue by:

  • Decreasing how much calcium is absorbed in the intestine and increasing the elimination of calcium in urine
  • Suppressing osteoblasts and osteocytes and increasing the activity of osteoclasts
  • Reducing estrogen and testosterone, hormones that contribute to bone health
"Because corticosteroids have a direct effect on the mineralization of bones, we try to limit the amount and duration of these medications when treating Crohn's disease," says Jakob Saidman, MD, a gastroenterologist at Northwell Health’s Lenox Hill Hospital in New York City. "Those who've been on corticosteroids for longer than three months should consider bone density screening."

When to Get Screened for Bone Disease

Bone loss is usually determined with the use of a technology called dual-energy X-ray absorptiometry, known as a DEXA or DXA scan.

This is the standard test for measuring bone density, and Dr. Saidman suggests that all adults with Crohn's should have a baseline scan with follow-up scans determined by other variables, such as age and time on steroid therapy.

Prevention and Management Strategies

Because there are many factors involved in developing osteopenia and osteoporosis, including genetic susceptibility, it's not always possible to prevent reduced bone density. But there are some meaningful strategies that can help prevent any bone loss that might be caused by lifestyle habits:

  • Talk with your gastroenterologist about using corticosteroids on a short-term basis only, as a bridge to nonsteroidal alternatives for long-term Crohn's remission maintenance.
  • Reduce alcohol consumption, as it affects calcium absorption and vitamin D activity.
  • Stop smoking or using other tobacco products; nicotine can impair bone health by hindering osteoblasts and increasing osteoclasts.
  • Engage in regular exercise, which has been shown to improve bone health.
  • Get some exposure to sunlight, which is an important source of vitamin D; use caution if you take a Crohn’s medication that makes you more sensitive to sunlight, however.

"The best prevention strategy is adequate treatment of Crohn's," says Pont. "After that, careful monitoring of vitamin D levels and DEXA screening if indicated can help detect osteoporosis early."

The Takeaway

  • People with Crohn’s disease are at increased risk for bone loss, including the development of osteopenia and osteoporosis.
  • Bone loss can begin at any age and can be caused by a number of factors, including malnutrition, hormone changes, prolonged steroid use, and lifestyle habits.
  • Declining bone density has no symptoms but can lead to easily broken bones.
  • Because of the absence of symptoms, it's important to get regular bone density screenings if you have Crohn's disease.

Resources We Trust

EDITORIAL SOURCES
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Waseem Ahmed, MD

Medical Reviewer

Waseem Ahmed, MD, is an assistant professor of medicine in the Karsh Division of Gastroenterology and Hepatology at Cedars-Sinai Medical Center in Los Angeles and serves as Director, Advanced Inflammatory Bowel Disease Fellowship and Education within the F. Widjaja Inflammatory Bowel Disease Institute.

He received his undergraduate degree from the University of Michigan and attended medical school at Indiana University. He then completed an internal medicine residency at New York University, followed by a fellowship in gastroenterology and hepatology at Indiana University, and an advanced fellowship in inflammatory bowel disease at the Jill Roberts Center for Inflammatory Bowel Disease at New York-Presbyterian Hospital/Weill Cornell Medicine. Prior to his current role, Dr. Ahmed served as an assistant professor of medicine within the Crohn’s and Colitis Center at the University of Colorado from 2021-2024.

Dr. Ahmed is passionate about providing innovative, comprehensive, and compassionate care for all patients with inflammatory bowel disease (IBD). His research interests include IBD medical education for patients, providers, and trainees; clinical trials; acute severe ulcerative colitis; and the use of combined advanced targeted therapy in high-risk IBD.

He enjoys spending time with his wife and dog, is an avid follower of professional tennis, and enjoys fine dining.

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Elizabeth Millard is a Minnesota-based freelance health writer. Her work has appeared in national outlets and medical institutions including Time, Women‘s Health, Self, Runner‘s World, Prevention, and more. She is an ACE Certified Personal Trainer and a Yoga Alliance Registered Yoga Teacher, and is trained in obesity management.

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