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Increased Risk of Osteoporosis for Patients with Rheumatoid Arthritis
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Posted on: 01/11/2007
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Patients with rheumatoid arthritis (RA) are two to four times more likely to have osteoporosis compared to the general population. This means they are also at greater risk of hip and vertebral fractures.
In this report, Dr. Kevin Deane from the Rheumatology Division at the University of Colorado Health Sciences Center (Denver) discusses the topic of osteoporosis in RA. Osteoporosis is a decrease in bone density or mass. Doctors must know how to prevent this problem. It's also important to recognize when it happens and treat it early.
Patients with RA are often given corticosteroids to reduce inflammation. These drugs cause bone loss leading to osteoporosis. Corticosteroids also weaken bone putting the patient at risk for fracture.
Dual-energy X-ray absorptiometry (DEXA) is still the best way to measure bone density. DEXA scanning should be done in premenopausal women to establish a baseline. Anyone with RA who is planning to go on corticosteroids should also be tested. DEXA scanning of all patients with RA is advised (men and women, with or without corticosteroids).
Steps to prevent OA include: stop all tobacco use, reduce amount of alcohol, and increase weight-bearing exercise. Patients should be on the lowest dose of corticosteroids at all times. Other drugs used to control RA-related inflammation also help reduce bone loss. These include anti-tumor necrosis factor (TNF) and disease modifying antirheumatic drugs (DMARDs).
Doctors should also recommend calcium and vitamin D supplements for all patients with RA. Bisphosphonates are prescribed to prevent bone loss if DEXA scanning shows bone density loss.
For anyone with continued bone loss despite all measures, parathyroid hormone (teriparatide) can be given. Dose and duration of therapy and precautions for use are discussed. Testosterone levels in men with RA and osteoporosis should be checked and treated if low.
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References:
Kevin Deane, MD. Osteoporosis in RA: A Common Comorbidity. In The Journal of Musculoskeletal Medicine. December 2006. Vol. 23. No. 12. Pp. 838-844.
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