Other conditions

Bones naturally have a porous honeycomb-like structure that provides strength and absorbs shock. Bone is made up of living tissue that is constantly broken down and replaced.

Osteoporosis occurs when the creation of new bone doesn’t keep up with the loss of old bone. This weakens the bone causing it to become brittle and less dense. Even mild stresses, such as coughing or minor bumps, can cause bone fractures (broken bones). Osteoporosis-related breaks most commonly occur in the hip, wrist or spine. ⁷

Over 1 million Australians have osteoporosis. Of those aged 50 years and over, 66 per cent have osteoporosis (very low bone density) or osteopenia (low bone density). There are over 183,000 broken bones each year due to poor bone health.⁸

Studies currently disagree on the extent of the connection between psoriasis and osteoporosis. However, they do agree that the two conditions share many overlapping elements, including chronic inflammation. Also, rheumatoid arthritis is known to be associated with osteoporosis, suggesting that psoriasis may also be associated with this bone disease.⁹

Many factors can increase the risk of osteoporosis. These include:

• Biological sex: Women are much more likely to develop osteoporosis than men.
• Age: The risk of osteoporosis increases with age.
• Race: People of white or Asian descent have a higher risk of osteoporosis than other races.
• Family history: People with a parent or sibling with osteoporosis are at greater risk, especially if their mother or father fractured a hip.
• Body frame size: Men and women who have small body frames tend to have a higher risk because they might have less bone mass to draw from as they age.
• Hormone levels: Osteoporosis is more common in people who have too much or too little of certain hormones in their bodies. For example:
  • Sex hormones: Lowered sex hormone levels tend to weaken bones. The fall in estrogen levels in women at menopause is one of the strongest risk factors for developing osteoporosis. Treatments for prostate cancer that reduce testosterone levels in men and treatments for breast cancer that reduce estrogen levels in women are likely to accelerate bone loss.
  • Thyroid problems: Too much thyroid hormone can cause bone loss.
  • Other glands: Osteoporosis has also been associated with overactive parathyroid and adrenal glands.
• Dietary factors: Osteoporosis is more likely to occur in people who have:
  • Low calcium intake: A lifelong lack of calcium plays a role in the development of osteoporosis. Low calcium intake contributes to diminished bone density, early bone loss and an increased risk of fractures.
  • Eating disorders: Severely restricting food intake and being underweight weakens bone in both men and women.
  • Gastrointestinal surgery: Surgery to reduce the size of the stomach or to remove part of the intestine limits the amount of surface area available to absorb nutrients, including calcium. These surgeries include those to help with weight loss and other gastrointestinal disorders.
• Steroids and other medicines: Long-term use of oral or injected corticosteroid medicines, (such as prednisolone) interferes with the bone-rebuilding process. Osteoporosis has also been associated with medications used to combat or prevent:
  • Seizures
  • Gastric reflux
  • Cancer
  • Transplant rejection
• Medical problems: The risk of osteoporosis is higher in people who have certain medical problems, including:
  • Celiac disease
  • Inflammatory bowel disease
  • Kidney or liver disease
  • Cancer
  • Multiple myeloma
  • Rheumatoid arthritis
• Lifestyle choices: Some bad habits can increase your risk of osteoporosis. Examples include:
  • Sedentary lifestyle.People who spend a lot of time sitting have a higher risk of osteoporosis than those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are good for the bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful.
  • Excessive alcohol consumption.Regular consumption of more than two alcoholic drinks a day increases the risk of osteoporosis.
  • Tobacco use.The exact role tobacco plays in osteoporosis isn’t clear, but it has been shown that tobacco use contributes to weak bones.⁷

Osteoporosis generally has no symptoms in its early stages; however, the bone structure has been damaged. Signs and symptoms may include:

• Back pain, caused by a broken or collapsed bone in the spine.
• Loss of height over time.
• A stooped posture.
• A bone that breaks much more easily than expected.⁷

Bone density can be measured with a scan (often called a DEXA scan).

For many people, osteoporosis can be prevented by being aware of their risk, modifying their lifestyle and actively improving their bone health. These strategies also help those who have been diagnosed to reduce their likelihood of further fractures. Some people may require medication to increase new bone generation or reduce bone cell reabsorption.

Broken bones are not only painful, they can lead to a loss of independence and increased disability. If you have any risk factors for osteoporosis, see your doctor to discuss prevention and fracture management strategies.

The relationship between autoimmune conditions (such as psoriasis) and infections is complex. Infections can both trigger autoimmune conditions and develop because of them. Also, underlying inflammation from such conditions can lead to a chronic, low-grade fever so it can be hard to detect if there is an active infection in the body. ¹⁰

People with autoimmune conditions have a higher risk of infection than otherwise healthy people but research results vary as to the extent of this.^11,12 We do know that:

• Autoimmune conditions themselves can disrupt the immune system enough to allow infections from external pathogens to develop.¹³
• Some comorbid conditions can compound infection risk.
• Some medications used to treat people with moderate to severe autoimmune conditions suppress the immune system therefore increasing the risk of infection. Examples of these medications include disease-modifying antirheumatic drugs (such as methotrexate, adalimumab and hydroxychloroquine) and glucocorticoids (such as prednisolone).¹¹

Types of infections people with autoimmune conditions may struggle to fight off easily include:

• Pneumocystis pneumonia (PCP)
• Symptomatic cytomegalovirus (CMV) infections
• Fungal infections (like coccidioidomycosis, cryptococcosis, and histoplasmosis) that spread to other areas of the body, outside of the lungs
• Frequent bacterial infections
• Frequent or long-lasting illness with pneumonia, herpes simplex, campylobacter or cyclosporiasis¹¹

Infection risks can be reduced with:

• Preventive measures: Such as washing hands, practising safe sex and following safe food handling practices.

• Vaccinations. Getting recommended vaccinations helps to reduce the risk of certain infections, such as COVID-19 and influenza. “Live” vaccinations are not recommended for people on some DMARD therapies.
• Pre- and post-exposure medications: People who have a higher risk of being exposed to HIV or who have been exposed to it may have access to prophylactic medications. In Australia, people with autoimmune conditions who take certain medications to suppress their immune system may be eligible for antiviral medications following a COVID-19 infection. These help to reduce the symptoms of infection.
• Limited exposure. Avoiding people who have a contagious infection, avoiding large crowds and using protective masks in public can help everybody reduce their chance of infection.
• Proactive treatments. Antibiotics or antifungal treatments are sometimes prescribed to prevent infections.
• Infectious disease screening. People with autoimmune conditions may be screened for some infections (including HIV, hepatitis, tuberculosis, fungal infections and parasitic infections) before starting treatment that can weaken the immune system.

(Learn more about managing respiratory infection risks in our article, How to manage common respiratory infections: Information for rheumatic disease patients.)

Talk to your doctor about your infection risks and the strategies you can use to avoid or manage infections. If you have an infection that you are concerned about, always see your doctor about it. Untreated infections can quickly become severe and life-threatening (especially for people with autoimmune conditions) so seek urgent medical attention if you have worsening or severe symptoms.

Cancer is a disease of the body’s cells. Healthy cells will grow and multiply in a regular pattern. Cancer refers to abnormal cells that grow in an out-of-control way. They can either cluster into lumps (tumours) or appear throughout the body (such as blood cancers).

Benign tumours aren’t cancerous and are usually not life-threatening. They grow slowly and some don’t need treatment. Others can grow to press on nearby body parts or grow in the brain or spinal cord. These usually need to be removed surgically but they generally do not grow back.

Malignant (cancerous) tumour cells often grow quickly. They can invade nearby cells or break away and spread through the body via the bloodstream or lymphatic system to form secondary cancers. Cancer can cause premature death because tumours can stop parts of the body from working properly.¹²

Cancer can affect people of any age. At current rates, it is expected about one in two Australians will be diagnosed with cancer by the age of 85.¹²

We do not know all the risks and causes of cancer. However, the most common risk factors known to trigger changes in the cells that cause cancer include:

• Smoking
• Alcohol use
• Dietary influences
• Infectious agents or exposure to radiation can cause cancer
• Genetic factors¹²

The association between psoriasis and cancer has been confirmed by numerous studies. However, studies looking at the reasons for this have come up with mixed results. We know that additional factors can all play a role for people with psoriasis but we don’t yet know for sure how much each factor contributes to cancer risk in isolation. These factors include:

• Systemic chronic inflammation
• Psoriasis comorbidities (including those involving chronic inflammation)
• Immunosuppressive and phototherapy treatments for psoriasis¹³

Reviews of research studies looking at the overall risk of cancer in people with psoriasis reveal confirmed associations between psoriasis and specific cancers including:

• Lymphomas (cancers that develop in the lymphatic system)
• Melanomas and non-melanoma skin cancers

Other cancers noted in these studies include lung, pancreatic, breast, thyroid and prostate cancers. While these cancers were associated with psoriasis, the relative risk levels appeared to be low. ¹³

Research into the cancer risk of various psoriasis treatments is ongoing and extensive but results often conflicting. Psoriasis treatments studied for their association with cancer include methotrexate, TNF inhibitor biologics, PUVA treatment (photochemotherapy), cyclosporine and others.

People with psoriasis ( especially people with a history of malignancies) and their treating health professionals should be aware of these potential cancer risks.

Some cancers have screening programs to find cancer early, but for other cancers, you need to be aware of what is normal for you and see your doctor if you notice any unusual changes. Early detection saves lives.

(See the Cancer Council website for information about cancer screening programs in Australia.)

While the physical symptoms of psoriasis are well-known, the condition can also have a significant impact on mental health. Many people with psoriasis experience anxiety, depression and social isolation due to the visible and often stigmatised nature of the disease. The extent of these impacts is not always related to the severity of the disease.

Many autoimmune conditions (such as type 1 diabetes or rheumatoid arthritis) don’t have obvious visible symptoms. This can be both a blessing and a curse. On one hand, people with an invisible condition can usually pick and choose when to discuss it with others. On the other hand, they might find others don’t believe them when they describe the symptoms they experience. Those who live with psoriasis, though, often find their symptoms can be difficult to hide as they can occur anywhere on the body.

Numerous research studies have looked at the links between psoriasis and mental health. One Danish study around 13,700 patients with psoriasis between 1977 and 2013. These patients were 75 per cent more likely to develop a mental health condition than the general population, and 72 per cent more likely to have depression. Around 5 per cent of the cohort had a mental disorder within 10 years of receiving a psoriasis diagnosis.¹⁴

Some of the factors that may cause people with psoriasis some distress include:

• Pre-diagnosis: The appearance of new, unrecognised symptoms plus delays to diagnosis
• Diagnosis: The shock of diagnosis and uncertainty about the future.
• Symptoms: Unsightly or uncomfortable symptoms, such as cracked skin, loose dead skin or damaged nails can negatively impact mood. Fatigue can also contribute to poor mental health.
• Treatments: Some topical psoriasis treatments are sticky and smelly so they can impact self-confidence and self-esteem. Anxiety about potential or actual treatment efficacy and side effects is also common.

The unpredictable nature of psoriasis can cause anxiety and make planning daily activities difficult for people with psoriasis. Similarly, they might feel anxious or embarrassed if they can’t do activities due to their condition. For many, the stigma they feel when others see their psoriasis erodes their self-esteem and is one of the hardest things to deal with.

Other emotions people with psoriasis often feel include:

• Grief from mourning for the life they led before developing psoriasis.
• Sadness from being rejected or mocked by others (such as being told they are just “lazy”).
• Uselessness or anger at themselves and their bodies for not being able to do the things they want to do.
• Irritability or moodiness (often compounded by poor sleep).
• Loneliness from being isolated at home or not being supported by those around them.

People with psoriasis need to be aware that they may not experience some or all of these mental health impacts. Or they might only experience them for short periods.

Learning strategies to cope with stress empowers you to rely less on outside forces for your wellbeing and improve your attitude, which is also important to help you heal.

Strategies to help you proactively manage your stress and improve your mental health include:

• Listening to your body. Know your signs of too much stress. For example, not exercising or eating well, having difficulty concentrating, experiencing mood swings or having a sense of losing control.
• Accepting your stress for what it is. Remind yourself that living with a chronic condition means you will have good and bad days so try not to feel bad about what you “should” be doing.
• Limiting or amending your activities in times of high stress. Multi-tasking can increase stress levels so only focus on the most essential tasks at hand. Anything else can wait.
• Deliberately slowing your breathing down if your breaths are shallow or your heart is pumping rapidly. Breathe deeply into your belly and exhale as slowly as possible.

When your stress is connected to internal sources such as pain or flares, use strategies that soothe and calm your body. If these don’t help, then you may need to draw on your other strategies such as taking medications or seeking support.

Mental health support

There’s no shame in seeking mental health support. It’s no different to seeing a doctor or physiotherapist for your physical health and it allows you to receive care on a more holistic level.

If you are struggling to deal with the mental or emotional effects of psoriasis, you can reach out for help via:

• Supportive friends or family
• Your GP
• A mental health practitioner
• A psoriasis support group in your area or online, such as Psoriasis and Psoriatic Arthritis in Australia or Australian Psoriatic Arthritis Warriors
• A psoriasis patient organisation, such as Psoriasis Australia (com/psoriasisaust) or email mailto:[email protected]
• Government websites such as Head to Health or healthdirect
• Not-for-profit organisations such as Beyond Blue or the Black Dog Institute

If this information has raised feelings that concern you, visit the Lifeline website or call 13 11 14.

(Subscribe to our free Psoriasis Wellness email series for valuable information and resources to help you live well with psoriasis.)

¹ Amador-Patarroyo MJ, Cristina Peñaranda A, Teresa Bernal M. Autoimmune uveitis. In: Anaya JM, Shoenfeld Y, Rojas-Villarraga A, et al., editors. Autoimmunity: From Bench to Bedside [Internet]. Bogota (Colombia): El Rosario University Press; 2013 Jul 18. Chapter 37. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459445

2 Iqbal KM, Hay MW, Emami-Naeini P. Medication-induced Uveitis: An Update. J Ophthalmic Vis Res. 2021 Jan 20;16(1):84-92. doi: 10.18502/jovr.v16i1.8254. PMID: 33520131; PMCID: PMC7841282. https://pmc.ncbi.nlm.nih.gov/articles/PMC7841282

³ Barisani-Asenbauer, T., Maca, S.M., Mejdoubi, L. et al. Uveitis- a rare disease often associated with systemic diseases and infections- a systematic review of 2619 patients. Orphanet J Rare Dis 7, 57 (2012). https://doi.org/10.1186/1750-1172-7-57

⁴ National Eye Institute: Uveitis. https://www.nei.nih.gov/learn-about-eye-health/eye-conditions-and-diseases/uveitis#:~:text=Doctors%20don’t%20always%20know,AIDS

⁵ Centre for Eye Research Australia: Eye Conditions – Uveitis. https://www.cera.org.au/conditions/uveitis

⁶ Fotiadou C, Lazaridou E. Psoriasis and uveitis: links and risks. Psoriasis (Auckl). 2019 Aug 28;9:91-96. doi: 10.2147/PTT.S179182. PMID: 31696050; PMCID: PMC6717847. https://pmc.ncbi.nlm.nih.gov/articles/PMC6717847

⁷ Mayo Clinic: Osteoporosis. https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968

⁸ Healthy Bones Australia: About Osteoporosis. https://healthybonesaustralia.org.au/your-bone-health/about-osteoporosis

⁹ Schauer A, Uthayakumar AK, Boardman G, Bunker CB. The risk of osteopenia/osteoporosis and psoriatic disease: A systematic review. Skin Health Dis. 2022 Sep 21;3(1):e169. doi: 10.1002/ski2.169. PMID: 36751315; PMCID: PMC9892432. https://pmc.ncbi.nlm.nih.gov/articles/PMC9892432/#ski2169-sec-0010

¹⁰ Galloway, J., & Cope, A. P. (2015). The ying and yang of fever in rheumatic disease. Clinical Medicine, 15(3), 288. https://doi.org/10.7861/clinmedicine.15-3-288

¹¹ Chen, C., Wang, C., N. Yiu, Z. Z., Lee, S., Chen, C., Chan, K. A., M. Griffiths, C. E., & Ashcroft, D. M. (2023). Risk of serious infection and infection mortality in patients with psoriasis: A nationwide cohort study using the Taiwan National Health Insurance claims database. Journal of the European Academy of Dermatology and Venereology, 38(1), 136-144. https://doi.org/10.1111/jdv.19466

¹² Yiu, Z. Z., Parisi, R., Lunt, M., Warren, R. B., Griffiths, C. E., Langan, S. M., & Ashcroft, D. M. (2020). Risk of hospitalization and death due to infection in people with psoriasis: A population‐based cohort study using the Clinical Practice Research Datalink. British Journal of Dermatology, 184(1), 78-86. https://doi.org/10.1111/bjd.19052

¹¹ Cleveland Clinic: Immunocompromised (Immunosuppressed). https://my.clevelandclinic.org/health/diseases/immunocompromised

¹² Cancer Council: What is Cancer? https://www.cancer.org.au/cancer-information/what-is-cancer

¹³ Bruni, M., Lobefaro, F., Pellegrini, C., Mastrangelo, M., Gualdi, G., Esposito, M., … Fargnoli, M. C. (2025). Psoriasis and cancer: the role of inflammation, immunosuppression, and cancer treatment. Expert Opinion on Biological Therapy, 25(4), 395–411.  Expert Review of Clinical Immunology, Volume 16, 2020 – Issue 5 https://doi.org/10.1080/14712598.2025.2471093

¹⁴ Leisner MZ, Riis JL, Schwartz S, Iversen L, Østergaard SD, Olsen MS. Psoriasis and Risk of Mental Disorders in Denmark. JAMA Dermatol. 2019;155(6):745–747. doi:10.1001/jamadermatol.2019.0039 https://jamanetwork.com/journals/jamadermatology/fullarticle/2732602