The Rheumatoid Arthritis-Osteoporosis Link
From the National Institutes of Health's Osteoporosis and Related Bone Diseases ~ National Resource Center
Studies have found an increased risk of bone loss and fracture in individuals with rheumatoid arthritis. People with rheumatoid arthritis are at increased risk for osteoporosis for many reasons. To begin with, the glucocorticoid medications often prescribed for the treatment of rheumatoid arthritis can trigger significant bone loss. In addition, pain and loss of joint function caused by the disease can result in inactivity, further increasing osteoporosis risk. Studies also show that bone loss in rheumatoid arthritis may occur as a direct result of the disease. The bone loss is most pronounced in areas immediately surrounding the affected joints. Of concern is the fact that women, a group already at increased osteoporosis risk, are two to three times more likely than men to have rheumatoid arthritis as well.
Osteoporosis Management Strategies
Strategies for preventing and treating osteoporosis in people with rheumatoid arthritis are not significantly different from the strategies for those who do not have the disease.
Nutrition. A well-balanced diet rich in calcium and vitamin D is important for healthy bones. Good sources of calcium include low-fat dairy products; dark green, leafy vegetables; and calcium-fortified foods and beverages. Supplements can help ensure that you get adequate amounts of calcium each day, especially in people with a proven milk allergy. The Institute of Medicine recommends a daily calcium intake of 1,000 mg (milligrams) for men and women up to age 50. Women over age 50 and men over age 70 should increase their intake to 1,200 mg daily.
Vitamin D plays an important role in calcium absorption and bone health. Food sources of vitamin D include egg yolks, saltwater fish, and liver. Many people, especially those who are older, may need vitamin D supplements to achieve the recommended intake of 600 to 800 IU (International Units) each day.
Exercise. Like muscle, bone is living tissue that responds to exercise by becoming stronger. The best exercise for your bones is weight-bearing exercise that forces you to work against gravity. Some examples include walking, climbing stairs, weight training and dancing.
Exercising can be challenging for people with rheumatoid arthritis. It needs to be balanced with rest when the disease is active. However, regular exercises such as walking can help prevent bone loss and, by enhancing balance and flexibility, can also reduce the likelihood of falling and breaking a bone. Exercise is also important for preserving joint mobility.
Healthy lifestyle.Smoking is bad for bones as well as the heart and lungs. Women who smoke tend to go through menopause earlier, resulting in earlier reduction in levels of the bone-preserving hormone estrogen and triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol also can have a negative effect on bone health. Those who drink heavily are more prone to bone loss and fracture, because of both poor nutrition and increased risk of falling.
Bone density test. A bone mineral density (BMD) test measures bone density in various parts of the body. This safe and painless test can detect osteoporosis before a fracture occurs and can predict one’s chances of fracturing in the future. The BMD test can help determine whether medication should be considered. People with rheumatoid arthritis, particularly those who have been receiving glucocorticoid therapy for 2 months or more, should talk to their doctor about whether a BMD test is appropriate.
Medication. Like rheumatoid arthritis, osteoporosis has no cure. However, medications are available to prevent and treat osteoporosis. The Food and Drug Administration has approved several medications (alendronate, risedronate, ibandronate, zoledronic acid, raloxifene, calcitonin, teriparatide, and estrogen/hormone therapy) for the prevention and/or treatment of osteoporosis in postmenopausal women. Alendronate and risedronate also are approved for use in men. For people with rheumatoid arthritis who have or are at risk for glucocorticoid-induced osteoporosis, alendronate (for treatment) and risedronate (for prevention and treatment) are approved.