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Bone Health with IBD


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People with IBD are at greater risk of developing bone loss. Osteoporosis and osteopenia are two forms of bone loss that can occur and have the potential to lead to an increased risk of fracture. 

Osteopenia is the first sign of bone mineral density (BMD) loss and cannot be felt. The inside of the bones are like a honeycomb structure and osteopenia is the process of weakening this structure. 

There is no cure for osteopenia or osteoporosis but it is possible to slow down the effects of bone loss through strategies we will go over later. When bone loss is not slowed down, osteopenia progresses to osteoporosis and the structure of the bone slowly becomes more porous and prone to fracture and breaks. 

“Bernstein et al [14] demonstrated that the incidence of fracture in persons with IBD is 40% greater than the general population.” (1)

Bone loss can happen due to inflammation, through the use of corticosteroids (like Prednisone), vitamin D deficiency, smoking, and surgery. 

When there is chronic inflammation there is an increase in cytokines. Cytokines can be both pro-inflammatory and anti-inflammatory. They are a protein in the body responsible for the growth and signaling of other cells in the body – immune cells and blood cells. Cytokines can contribute to a decrease in bone formation (1).

Strategies to decrease bone density loss

  • Inflammation control
  • Quit smoking
  • Following a balanced diet rich in vitamins and minerals
  • Remain active with a particular focus on strength training
  • Reduce consumption of alcohol
  • Talk to your doctor, pharmacist, or dietitian to see if calcium supplementation is right for you

Nutrition strategies to support bone health

  • Stay up to date on lab work – check levels of inflammation through CRP and fecal calprotectin, vitamin D levels, calcium levels….
  • Follow a balanced diet with emphasis on calcium protein, and vitamin D


Calcium is the main ingredient to help make bones and is essential for heart, cell, muscle, and bone health. If we do not get enough calcium from our diet (or supplements), our body steals calcium from our bones to carry out the functions needed to support itself. 

The Recommended Dietary Allowance (RDA) for males and females 19-50 is 1000 mg/day. For females age 50-71 is 1200 mg/day and males remain at 1000 mg/day. 

Food sources of calcium can even include tofu, soy milk, beans, almonds, and leafy greens like spinach and kale. 


Proteins are the building blocks of so many things in your body including the muscles that support your bones & joints!

Vitamin D

Vitamin D helps our body absorb calcium. Which is why vitamin D is so important for the health of those with IBD.

Vitamin D can be synthesized from the sun, and found in fatty fish (like salmon), mushrooms, as well as fortified milk and juice products. However, if someone is deficient in vitamin D, it is very difficult to get the required amount from food alone. 

The RDA for vitamin D is 600 international units (IUs) for healthy adults. Supplementation for IBD can be anywhere from 2000-10,000 IUs a day. Please check with your healthcare provider for specific recommendations if you are deficient.