Your Bone-Friendly AS Diet Is Here

by Marjorie Korn Health Writer

There’s nothing easy about managing ankylosing spondylitis (AS). A form of arthritis, the inflammatory disease often starts out with lower back pain, stiffness, neck pain, and overtiredness. As it progresses, small bones in the vertebrae fuse causing the spine to lose flexibility, which is why some people with AS begin to hunch over. About two-thirds of patients also report grueling fatigue, according to a study in Clinical Rheumatology. But these symptoms are only the beginning of your problems.

bone density

Beefing Up Your Bone Health

Along with pain, loss of mobility, and fatigue, add this to the list: Osteoporosis, a disease that weakens bones over time and leads to breaks that take longer to heal or don’t heal completely, affects one in five people with AS. It is a complex condition that is compounded by things like nutrition, fitness, muscle mass, age, and gender. You need to take action now to avoid potential problems later.

Doctors reviewing low back/hip x-ray

AS and Osteoporosis

“There is a rapid loss of bone in these patients, particularly those with high disease activity,” says Marina Magrey, M.D., director of the Spondyloarthritis Center at MetroHealth Medical Center and a professor at Case Western Reserve University School of Medicine in Cleveland. To keep tabs on your bone health, your doctor may order a bone mineral density screening in the first year of diagnosis, and every two years after that.

adult drinking milk

The 411 on Calcium

Calcium is one of the main ways to maintain strong bones and stave off osteoporosis. The American Association of Clinical Endocrinologists recommends the following daily calcium intake for AS patients (your individual needs may vary, so talk with your doctor):

  • Age 19 to 50 years: 1,000 mg/day
  • Females age 51 and older: 1,200 mg/day
  • Males age 51 to 70: 1,000 mg/day
  • Males age 71 and older: 1,200 mg/day
calcium pills

Should You Take a Supplement?

One thing to note: Osteoporosis that happens as a result of hormone level disruptions (like during menopause) has different roots than the osteo experienced by people with AS. For instance, people with AS can also develop GI disorders like Crohn’s disease, meaning their gut doesn’t fully absorb nutrients, contributing to calcium deficiencies. Researchers are still looking into the long-term use of calcium supplements for AS.

eggs and butter

Vitamin D Matters, Too

“About 51% of patients with AS have vitamin D deficiency and it's associated with increased disease severity,” Dr. Magrey says. In general, aim for about 800 IU of vitamin D daily, which can come in a tablet (and is often combined with calcium), or can be found in eggs, butter, fatty fish like salmon, and fortified foods including juice and cereal. (Your doc may want to check your vitamin D levels to guide supplementation.) Other factors for bone health include vitamins C, K1, and K2, magnesium, copper, manganese, and essential fatty acids.

collard greens

Adding Calcium to Your Diet

If you’re looking to add more high-calcium foods, start with dairy. A quarter-cup of mozzarella cheese contains 141.5 mg of calcium, while a cup of 1% milk contains 349 mg. (Eight ounces of vanilla ice cream? That's 85 mg of calcium!) Other calcium-containing foods include sardines, canned salmon with bones, calcium-fortified beverages (juice or non-dairy milks), tofu, collard and turnip greens, broccoli rabe, bok choy, kale, and dried figs.

whole foods

Focus on Anti-Inflammatory Foods

You can help fight the inflammation caused by AS through your diet, says holistic nutritionist Katie LeBlanc, founder of Restoring Autoimmune Health in Vancouver. She has lived with AS for more than a decade and has helped treat her condition through her diet. “Prioritizing whole foods and cooking from scratch is beneficial when it comes to inflammation and bone health,” LeBlanc says. “Eating a variety of leafy greens, quality fats, fiber, and calcium-rich foods is also important.”


Steer Clear of Simple Carbs

Of course, there are some no-no’s, too. “Avoid processed food, refined sugar, heated vegetable oils, alcohol, and excess caffeine,” LeBlanc says. “Harmful bacteria in the microbiome feed off sugar and simple carbohydrates, while beneficial bacteria feed off of fiber and fermented foods. Prioritizing the latter is important for gut health.” Translation: Skip deep-fried foods and dig into kimchi.


Work It Out

Along with diet, exercise holds the key to bone health with AS. Load-bearing activities like walking and cardio classes are good choices (as opposed to non-load bearing, like swimming). And don’t forget about pumping some iron—it helps increase bone density, but it's site-specific: The part of your body you’re strength-training will get the bone benefits, while passive parts won’t. So be sure to work out all your parts! Talk with your doctor for general safety guidelines first, and consider a trainer who specializes in clients with arthritis or spine conditions.

Marjorie Korn
Meet Our Writer
Marjorie Korn

Marjorie Korn is a health, medicine, and features writer based in New York City. She is also a Narrative Medicine instructor at Columbia University College of Physicians & Surgeons.