Joint damage in the spine is a major concern for people with ankylosing spondylitis. In particular, there’s a risk for the development of bone spurs called syndesmophytes that may fuse vertebrae together, causing the spine to become rigid, says Susan M. Goodman, MD, a rheumatologist at the Hospital for Special Surgery in New York City.
“One of the paradoxes of ankylosing spondylitis is the combination of syndesmophyte, or bone growth, and osteoporosis, or bone resorption, occurring simultaneously in inflammatory disease,” Dr. Goodman explains.
To help address these potential complications and maintain your joint and bone health, start with these steps.
1. Avoid Alcohol to Help Keep Bones Strong
Alcohol can weaken your bones, according to the Spondylitis Association of America (SAA), particularly if you have more than two drinks a day. Alcohol can also interact with medications for ankylosing spondylitis. “Alcohol can be risky with some medications for ankylosing spondylitis, and it’s also a risk factor for osteoporosis when taken to excess,” Goodman notes.
It may be okay to drink in moderation, however, even with ankylosing spondylitis, she adds. Moderate drinking is defined as up to one drink a day for women and up to two drinks a day for men, according to the National Institute on Alcohol Abuse and Alcoholism. Talk to your doctor about whether alcohol will interfere with your medication.
2. Get Plenty of Calcium and Vitamin D — the Building Blocks of Bone
Even if you don’t drink to excess, ankylosing spondylitis may increase your risk for osteoporosis and bone fractures, according to the SAA. For bone health, load up on both calcium and vitamin D, which are essential nutrients that work together as a team. Calcium is needed to build and maintain bones; vitamin D helps your body absorb calcium. The National Osteoporosis Foundation recommends 1,000 milligrams of calcium daily for women up to age 50 and men up to age 70, after which everyone should get 1,200 mg daily. Dairy products are good sources of calcium. Daily recommendations for vitamin D are 400 to 800 IU for men and women under 50, and then 800 to 1,000 IU for those over 50. Sunlight, fatty fish, fortified foods, and supplements are sources of vitamin D. “It’s very important to carefully assess bone health with a bone mineral density study, and ensure that patients are getting enough vitamin D,” Goodman says.
3. Get Active to Prevent Stiffness
Exercise, particularly stretching and weight-bearing activities, can protect against joint damage, according to the SAA. It can also help prevent some of the stiffness that comes with ankylosing spondylitis. You can work with a physical therapist to determine the best type and intensity of exercise for you. For example, low-impact activities like walking and swimming are generally easier on joints than running, tennis, and soccer. Walk on a flat surface to reduce joint strain and gently stretch for better flexibility and function.
4. Wear Good Shoes to Help Prevent Falls
It’s especially important to minimize the risk of falling because ankylosing spondylitis often leaves the bones in the neck and back more fragile and more susceptible to fracture. To stay steady on your feet, invest in stable, secure, properly fitting footwear that has good support and cushioning to help protect your foot and ankle joints. Wearing proper shoes may also help reduce the likelihood of plantar fasciitis, a common cause of heel pain that often occurs in people with ankylosing spondylitis.
5. Practice Good Posture to Keep Your Spine Flexible
Concentrate on the alignment of your spine to alleviate pain and prevent damage. As ankylosing spondylitis progresses, it may cause permanent flexion — or forward tilting — in your neck and back. Stretching your neck, upper back, and shoulders can help maintain flexibility. Try to stretch several times throughout the day for a few minutes at a time. Also, focus on stretching your neck and standing and sitting “tall,” keeping your chin centered and parallel to the floor, the SAA recommends. You can even protect yourself when you sleep: Stick to a thin, flat pillow (or no pillow) to prevent too much flexion in your neck.