Rheumatoid Arthritis and Osteoporosis

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:

• Glucocorticoid (corticosteroid) medications such as prednisone often prescribed for the treatment of rheumatoid arthritis can trigger significant bone loss.
• 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.

Also of concern is the fact that women, a group already at increased osteoporosis risk, are two to three times more likely than men to suffer from rheumatoid arthritis as well.

Rheumatoid arthritis (RA) is an autoimmune disease, a disorder in which the body attacks its own healthy cells and tissues. In rheumatoid arthritis the membranes surrounding the joints become inflamed and release enzymes that cause the surrounding cartilage and bone to wear away. In severe cases, other tissues and body organs also can be affected.

Individuals with rheumatoid arthritis often experience pain, swelling and stiffness in their joints, especially those in the hands and feet. Limited motion of the affected joints can also occur, curtailing one's ability to accomplish even the most basic everyday tasks. About one-quarter of those with rheumatoid arthritis can develop rheumatoid nodules (bumps) that grow under the skin, usually close to the joints. Other symptoms that can also occur in individuals with rheumatoid arthritis include:

• fatigue
• anemia (low blood cell count)
• neck pain
• dry eyes
• dry mouth

According to NIAMS, it is estimated that about 2.1 million people in the United States have rheumatoid arthritis. The disease occurs in all racial and ethnic groups, but affects two to three times as many women as men. Rheumatoid arthritis is more commonly found in older individuals, though the disease typically begins in middle age. Children and young adults can also be affected.

Juvenile rheumatoid arthritis (JRA) occurs in children sixteen years of age or younger. Children with severe juvenile rheumatoid arthritis may be candidates for glucocorticoid (corticosteroid) medication, the use of which has been linked to bone loss in children as well as adults. Physical activity can be challenging in children with juvenile rheumatoid arthritis since it may cause pain. Incorporating physical activities recommended by the child's physician, and a diet rich in calcium and vitamin D are especially important for these children to help optimize peak bone mass and reduce the risk of future fracture.

• Osteoporosis Prevention for Kids: A Guide for Parents

Osteoporosis is a condition in which the bones become less dense and more likely to fracture. Fractures from osteoporosis can result in significant pain and disability. It is a major health threat for an estimated 44 million Americans, 80% of whom are women.Osteoporosis Risk Factors

Risk factors for developing osteoporosis include:

• thinness or small frame
• family history of the disease
• for women, being postmenopausal, having an early menopause, or not having menstrual periods (amenorrhea)
• abnormal absence of menstrual periods
• prolonged use of certain medications (such as corticosteroids)
• low calcium intake
• physical inactivity
• smoking
• excessive alcohol intake

Osteoporosis is a silent disease that can often be prevented. However, if undetected, it can progress for many years without symptoms until a fracture occurs.

Strategies for the prevention and treatment of osteoporosis in people with rheumatoid arthritis are not significantly different from the strategies for those who do not have the disease.

A 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
• calcium fortified foods and beverages

Calcium supplements can also help ensure that the calcium requirement is met each day.

• Calcium Supplements: What Should You Look For?

Vitamin D plays an important role in calcium absorption and bone health. It is synthesized in the skin through exposure to sunlight. While many people are able to obtain enough vitamin D naturally, older individuals are often deficient in this vitamin due, in part, to limited time spent outdoors. Such individuals may require vitamin D supplements in order to ensure an adequate daily intake.

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
• stair-climbing
• dancing

Exercising can be challenging for people with rheumatoid arthritis and needs to be balanced with rest when the disease is active.

Regular arthritis-friendly exercises such as walking can help prevent bone loss and, by enhancing balance and flexibility, can reduce the likelihood of falling and breaking a bone. Exercise is also important for preserving joint mobility.

• Exercise: Essential Treatment for Arthritis
• How to Exercise When You Have Arthritis
• Strength Training for People With Arthritis

Smoking is bad for bones as well as the heart and lungs. Women who smoke tend to go through menopause earlier, triggering earlier bone loss. In addition, smokers may absorb less calcium from their diets. Alcohol can also negatively affect bone health. Those who drink heavily are more prone to bone loss and fracture, both because of poor nutrition as well as increased risk of falling.

Specialized tests known as bone mineral density (BMD) tests measure bone density in various sites of the body. These tests can detect osteoporosis before a fracture occurs and predict one's chances of fracturing in the future. Rheumatoid arthritis patients, particularly those receiving corticosteroid (glucocorticoid) therapy for two months or more, should talk to their doctors about whether they might be a candidate for a bone density test.

Osteoporosis Medications

Like rheumatoid arthritis, there is no cure for osteoporosis. However, there are medications available for the prevention and treatment of osteoporosis. Several medications and drug options are approved by the Food and Drug Administration (FDA) for the prevention and/or treatment of osteoporosis in post-menopausal women these include:

• Fosamax (alendronate)
• Actonel (risedronate)
• Boniva (ibandronate)
• Didronel (etidronate)
• Evista (raloxifene)
• Miacalcin (calcitonin)
• Forteo (teriparatide)
• estrogen/hormone therapy

Alendronate is also approved for use in men. For rheumatoid arthritis patients on corticosteroid (glucocortiocoid) drugs such as prednisone, alendronate (for treatment) and risedronate (for prevention and treatment) are approved for glucocorticoid-induced osteoporosis.