Bone Health Matters: What You Need to Know

Exercising and maintaining strong, healthy bones is important for everyone, but it’s especially important for those with Addison’s disease or adrenal insufficiency. Due to the lifelong need for steroid replacement therapy and other risk factors, people with adrenal insufficiency may be at risk of developing osteopenia or osteoporosis. The good news is, there are plenty of ways you can help protect and strengthen your bones.  

Steroid Medication and Bone Health 

People with Addison’s disease or adrenal insufficiency take a replacement dose of steroid medication to mimic the natural cortisol produced by functioning adrenal glands. There is no robust evidence to suggest replacement doses of steroid medication negatively impact bone health. However, regular use of higher-than-replacement doses (“over-replacement”) can have adverse effects on bones. 

To ensure this is monitored,the NICE guidelines on the identification and management of adrenal insufficiency, recommend that people with Addison’s or adrenal insufficiency receive at least one bone density scan (DEXA/ DXA scan) within five years of diagnosis. DXA scans measure bone density and lower bone density can indicate conditions like osteopenia/osteoporosis.

“Bone mineral density scan as needed” is also a recommendation from the Society for Endocrinology, Consultation Reference Guide. 

Low levels of dehydroepiandrosterone (DHEA), a hormone produced by the outer layer of the adrenal gland, are associated with reduced bone mineral density. Studies have shown small positive effects on bone density for people (especially postmenopausal women) with adrenal insufficiency when supplemented with DHEA under the guidance of their endocrine team. However the impact is not as strong as conventional bone density treatments, such as calcium and vitamin D. Learn more about DHEA.

The Influence of Hormones on Bone Mass 

Peak bone mass is typically achieved between the ages of 20 and 25. From around age 40, bone density naturally declines gradually as part of the ageing process. This decline is more significant in women, largely due to the reduction in oestrogen levels leading up to and during menopause. Oestrogen is essential for protecting bone health in women, just as testosterone plays a similar role in men. These hormonal differences help explain why patterns of bone loss is different between men and women. 

Maintaining Bone Health 

Bone health is important! Factors such as smoking, alcohol consumption, weight, medications, level of activity and lifestyle choices can all affect bone density. There are several ways you can support and strengthen your bone health if you’re living with Addison’s disease or adrenal insufficiency: 

1. Get enough calcium and vitamin D
2. Weight-bearing and muscle-strengthening exercises
3. Lifestyle habits

1. Get Enough Calcium and Vitamin D 

Calcium: Calcium is essential for teeth and bone strength (amongst many other benefits) and as we get older we tend to absorb less from the food that we eat. Online calcium calculators are a great way to assess whether you’re consuming enough calcium in your diet.  

Vitamin D: Vitamin D helps the body to absorb calcium. While we can get it from sunlight and diet, it’s often hard to get enough from these sources alone (especially with the British weather!), so many people benefit from supplementation. The NHS advises everyone in the UK to take a vitamin D supplement during the autumn and winter months  of 10 micrograms daily. 

If you are concerned about poor bone health, calcium and/or vitamin D levels, checks can be discussed at your next endocrine appointment or with your GP. 

2. Weight-Bearing and Muscle-Strengthening Exercises 

Weight-bearing and muscle-strengthening exercises are important to strengthen and maintain bone health, and it’s not just about lifting weights! They involve any exercise where your body carries your own body weight (in a standing position). Examples include fast walking, running, stair climbing and dancing.  

Aim for 30 minutes of weight-bearing activity, 3–5 times a week, if possible. This is where walking can be a great place to get started!  If you’re looking to explore weight-bearing exercise, the Royal Osteoporosis Society has a brilliant “Exercise for bones” page, for more detailed guidance. 

Exercise for bones

Remember that during exercise, you may need to take extra steroid medication due to the stress or unaccustomed exertion on your body. The table below offers a guideline for dosing but remember that everyone is different and you should always listen to your body, so you may need to adapt this for your own exercise regimen. For more guidance and for information on fludrocortisone for those with Addison’s, please visit our exercise page.

Personal Experiences

We can gain valuable insights from others with Addison’s and adrenal insufficiency through their personal experiences. Crystal, a personal trainer with Addison's, has shared her tips for weight bearing exercises as well as her experiences taking part in powerlifting competitions in her blog. You can also read about Ingrid, who made an inspired return to the gym at 80 years old. If you'd like to chat with others, join the conversation in the Exercise and Fitness section of our online forum.

Crystal's Blog

"From diagnosis into strength - the power of exercise for my Addison’s"

Ingrid's Blog

"Exercising with Addison's"

Online Forum

Chat about everything exercise and fitness!

3. Lifestyle Habits  

Smoking and alcohol negatively impact bone health. Smoking is harmful to bones and alcohol interferes with calcium absorption in the stomach. As with the general population, maintaining a balanced diet is essential. Key nutrients that support bone structure include protein, magnesium, vitamin K, and of course, calcium.