If you live with fatigue and osteoporosis, your fatigue may be related to side effects of medication, an underlying health condition, or simply a lack of vitamin D — not the bone disease itself. Some members of MyOsteoTeam who say they’re tired all the time have also been diagnosed with arthritis, chronic fatigue, underactive thyroid, sleep apnea, and other medical conditions that can cause fatigue.

No matter the root cause, fatigue is a common experience among MyOsteoTeam members. “Even after a good night’s sleep, I’m falling asleep in my chair at 11 a.m.,” said one member. “By 12 noon, I'm so tired, I've got to take a nap just to make it to dinner,” shared another member.

The Connection Between Fatigue and Bone Density

It’s not clear why people with osteoporosis often experience fatigue, but a lack of sleep may increase the risk of fractures — and vice versa, according to recent research.

A 2019 study published in the Journal of Bone and Mineral Research concluded that less sleep is associated with lower bone mineral density (BMD) and a higher risk for osteoporosis in women who are postmenopausal. A 2018 analysis of 157,000 women in the Women’s Health Initiative further suggested that those who slept less than five hours a night had a 27 percent increased chance of recurrent falls. The Study of Osteoporotic Fractures, an ongoing research effort by the National Institutes of Health since 1986, found that women with the same sleep deficit had a 50 percent risk of two or more falls.

Osteoporosis Medications That Can Lead to Fatigue

Osteoporosis occurs when the body loses too much bone mass, or doesn’t build new bone fast enough, increasing the risk of fractures. Some medications prescribed to promote bone health and bone density can cause side effects that may disturb sleep and promote fatigue.

Many MyOsteoTeam members taking Prolia (Denosumab), an osteoporosis drug given to postmenopausal women with a high risk of bone fractures, reported frequent nocturnal trips to the bathroom. “Every night I wake up, sometimes four times, because I need to pee,” said one member.

Another woman taking Forteo (Teriparatide [rDNA origin]), a drug that increases bone density and bone strength, got nighttime cramps. Others reported general fatigue from Tymlos (Abaloparatide). “When I was on that therapy for a year, the fatigue doubled,” said one member of MyOsteoTeam.

If you suspect your fatigue may be related to a medication prescribed for osteoporosis, talk to your doctor. They can help identify the source of the fatigue and manage any side effects related to osteoporosis medications.

Other Medications That Can Cause Fatigue

Fatigue can also be a side effect of drugs prescribed for other common medical conditions affecting postmenopausal women. Medications that treat heart problems, for example, can cause sleeplessness. So can some antidepressants, thyroid medications, and decongestants, according to the National Sleep Foundation. Some drugs may contain stimulants, including medications for asthma, smoking cessation, and pain. “I’ve been getting a good night’s sleep since being off strong painkillers,” shared one member of MyOsteoTeam.

Long-term use of oral or injected steroids, such as Prednisone and Cortisone, are also known to interfere with sleep. At the same time, they can worsen osteoporosis, causing a loss of 10 percent to 20 percent of bone mass within the first six months of corticosteroid therapy, according to the Hospital for Special Surgery.

One MyOsteoTeam member who has multiple autoimmune disorders said, “Most of my medicines cause fatigue.”

Many members of MyOsteoTeam who are fatigued agree that dealing with the daily pain associated with aging, arthritis, and related conditions zaps their energy. “I'm exhausted every evening when the pain is at its worst and I can’t sleep,” said one member. Another agreed, “Yes, pain is exhausting.”

Poor eating habits, excess weight, lack of weight-bearing exercise, and other lifestyle issues also contribute to fatigue.

Medical Conditions That Can Cause Fatigue

Certain chronic diseases can increase the risk of osteoporosis and fatigue. Known as secondary causes of osteoporosis, they affect about two-thirds of men, more than 50 percent of premenopausal women, and one-fifth of postmenopausal women.

Cushing's disease, rheumatoid arthritis, multiple sclerosis, diabetes, multiple myeloma, and leukemia are secondary conditions that can cause low bone density and fatigue. A 2018 study found that living with long-term mental, emotional, or physical stress that taxes adrenal glands has a direct, detrimental effect on bone mass. More than 2,300 members of MyOsteoTeam report experiencing depression or anxiety.

MyOsteoTeam Members’ Tips for Beating Fatigue

Many members of MyOsteoTeam have taken steps to relieve their fatigue.

Vitamin D and Dietary Supplements

Vitamin D deficiency is known to cause fatigue, muscle weakness, and brittle bones. Lack of vitamin B12, magnesium, or potassium can also contribute to exhaustion and fatigue. Some members learned they had an iron deficiency, which can create sluggishness. “I’ve been on an iron supplement for two months and don't tire as easily anymore,” explained one member.

A routine blood test can identify nutritional deficiencies. Speak to your doctor about testing if you suspect you may have a nutritional imbalance.

Many members use a range of dietary supplements to combat fatigue. “I’m finally getting a good night's rest,” said one member. “If anyone wants pictures of the supplements I'm taking, let me know.”

Always consult your doctor before adding dietary supplements to your routine. Some supplements can cause dangerous interactions with medications or cause side effects of their own.

Exercise and Gentle Movement

Although it may be challenging to get off the couch when you’re fatigued, MyOsteoTeam members say exercise boosts their energy.

“When I’m in my exercise routine, I feel heaps better,” said one member. Another said, “I’ve always pushed myself — the more I do, the better I feel.” “On the days I walk, I sleep better,” said a third.

“Osteoporosis has nothing to do with us getting more tired,” said one member. “Much of it is age and sitting around letting our muscles atrophy.” Another said, “The old saying ‘Use it or lose it’ is so true.”

Some members worry about the risk of falls or fractures while exercising. One woman recently learned that weak bones are causing her muscles to “work overtime to compensate. Muscles tire more rapidly as a result. It’s causing pain, discomfort, and my body is exhausted.” Before starting any new weight-bearing exercise program, always get proper medical advice to make sure it’s safe for you.

You Are Not Alone: Finding Support for Osteoporosis and Fatigue

By joining MyOsteoTeam, the social network and online support group for those living with osteoporosis, you gain a community more than 36,000 members strong. Coping with fatigue is one of the most discussed topics.

Here are some question-and-answer threads about managing osteoporosis and fatigue:

• "I seem to tire more easily. Is this part of having osteoporosis?"
• "Does anybody have pain and fatigue after 4 p.m.?"
• "Why do I get so tired?"

Here are some conversations about coping with osteoporosis and fatigue:

• “Haven’t slept well for the past three nights.”
• “What gets me the worst is fatigue. I can't cope with it.”
• “I have more energy when I focus on work.”
• “Fatigue and back and neck pain have been an issue.”

How does fatigue affect you? Have you found effective ways to cope with fatigue? Share your tips and experiences in a comment below or on MyOsteoTeam. You'll be surprised how many others have similar stories.