Rheumatoid Arthritis and Osteoporosis

RA increases the risk of bone loss and fracture

If you have rheumatoid arthritis (RA), studies show you also have a greater risk of developing osteoporosis, which can make your bones weak and prone to breaking. Studies have estimated that about a third of people with RA experience bone loss. This is especially important for women to know, since they're significantly more likely than men to develop either condition.

Possible Connections

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

Rheumatoid arthritis is an autoimmune disease, which means the immune system attacks the body's own healthy cells and tissues. It is best known for its effect on the joints; membranes surrounding them become inflamed and cause RA symptoms.

Researchers have found several possible reasons for the overlap between these two diseases:

  • Bone loss may occur as a direct result of RA. Enzymes that get released with inflammation cause surrounding cartilage and bone to wear away. The bone loss is most pronounced in areas immediately surrounding the affected joints.
  • Pain, swelling, fatigue, and loss of joint function due to RA often make it hard to accomplish even the most basic everyday tasks, let alone to remain active at optimal levels. Inactivity increases the risk of osteoporosis.
  • Glucocorticoid (corticosteroid) medications, such as prednisone, can trigger significant bone loss. These drugs are often prescribed for RA, including the juvenile form of the disease (called juvenile idiopathic arthrits).
  • Loss of estrogen in women as they age is linked to both osteoporosis and immune-system changes that may contribute to developing RA.

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

Diagnosing Osteoporosis

Your doctor can check you for osteoporosis by using specialized tests known as bone mineral density (BMD) tests, such as dual energy X-ray absorptiometry (DEXA scan).

These evaluate bone density in various sites of your body and can detect osteoporosis before a fracture occurs. Bone density measurements can also predict your risk of future fractures.

If you have RA, and especially if you have general risk factors for osteoporosis or have been on a corticosteroid for more than two months, talk to your doctor about whether you should have a bone density test.

Prevention and Treatment

Strategies for preventing and treating osteoporosis aren't significantly different for people with RA than they are for anyone else.

Calcium and Vitamin D

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

Vitamin D is synthesized in the skin through exposure to sunlight. It's also available in fortified foods and beverages, such as milk. You may be able to obtain enough vitamin D naturally, but if your RA symptoms tend to keep you inside a lot, you may be at risk of developing a deficiency.

Ask your doctor about how much calcium and vitamin D you should be getting and whether you should consider dietary supplement to ensure you are consistently meeting the required amounts.


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 RA and needs to be balanced with rest when the disease is active. Do what you can, when you can.

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

Smoking and Drinking

Smoking is bad for bones, and it can exacerbate both osteoporosis and RA.

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. Alcohol may also have a negative impact on RA symptoms, and it can interact negatively with RA medications.

Osteoporosis Drugs

Osteoporosis can't be cured, but medications are available that can slow bone loss and even increase bone density, which lowers your risk of fractures.

Common osteoporosis drugs include:

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

Fosamax and Actonel are specifically approved for glucocorticoid-induced osteoporosis, so one of those may be a good option if you're taking prednisone or a related medication.

A Word From Verywell

Managing two chronic conditions can be challenging, especially when they can make each other worse. It's important to keep in mind that both of these conditions can be successfully treated and managed. Communicating with your doctor, staying on your treatments, and developing healthy habits can get you on the road to feeling better and safeguarding your future bone and joint health.

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Article Sources
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