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. RA causes pain and damage in your joints, while osteoporosis can make your bones weak and more likely to break.

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 much more likely than men to develop either condition.

This article discusses why RA is linked to osteoporosis. It also covers how osteoporosis is diagnosed and how you can prevent or treat it.

Possible Connections

Osteoporosis is a condition in which the bones become less dense, or thick, and more likely to break. This 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. The lining surrounding the joints becomes inflamed and causes RA symptoms, such as joint pain, stiffness, and swelling.

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 worse in areas immediately surrounding the affected joints.
  • Pain, swelling, fatigue, and loss of joint function due to RA often make it hard to stay active. Inactivity increases the risk of osteoporosis.
  • Glucocorticoid (corticosteroid) medications, such as prednisone, can trigger significant bone loss. These drugs are often prescribed for RA as well as juvenile idiopathic arthritis.
  • 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 break in the bone occurs.

Diagnosing Osteoporosis

Your healthcare provider 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 areas of your body and can detect osteoporosis before a fracture occurs. Bone density measurements can also predict your risk of future breaks in the bone.

Talk to your practitioner about a bone density test if:

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 made in the skin through exposure to sunlight. It's also available in certain foods and beverages, such as milk. You may be able to get enough vitamin D naturally. However, if your RA symptoms tend to keep you indoors a lot, you may not be getting enough.

Ask your healthcare provider about how much calcium and vitamin D you should be getting. They can tell you if you should consider a dietary supplement to get 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. By improving balance and flexibility, it can also reduce the likelihood of falling and breaking a bone. Exercise is also important for preserving joint mobility, which can be worse with RA.

Smoking and Drinking

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

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 at risk for bone loss and breaks. This is because of poor nutrition as well as an increased risk of falling.

Alcohol may also make RA symptoms worse, and it can interact negatively with RA medications.


To help prevent osteoporosis, make sure you're getting enough vitamin D, calcium, and exercise. Avoid drinking too much alcohol and smoking, since both can lead to bone loss.

Osteoporosis Drugs

Osteoporosis can't be cured. However, 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 osteoporosis caused by glucocorticoid medications. One of those may be a good option if you're taking prednisone or another glucocorticoid medication for your RA.


RA can lead to an increased risk of osteoporosis. However, there are things you can do to help prevent it, like exercising and getting enough vitamin D and calcium. If you have osteoporosis, there are medications that can increase your bone health.

Check with your doctor if you have RA to ask about getting tested for osteoporosis.

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.

Communicate with your doctor, stay on your treatments, and develop healthy habits to protect your future bone and joint health.

6 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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  3. Shim JH, Stavre Z, Gravallese EM. Bone loss in rheumatoid arthritis: Basic mechanisms and clinical implicationsCalcif Tissue Int. 2018;102(5):533-546. doi:10.1007/s00223-017-0373-1

  4. National Institutes of Health: National Institute of Arthritis and Musculoskeletal and Skin Diseases. Bed rest and immobilization: Risk factors for bone loss.

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  6. Sapir-Koren R, Livshits G. Postmenopausal osteoporosis in rheumatoid arthritis: The estrogen deficiency-immune mechanisms linkBone. 2017;103:102-115. doi:10.1016/j.bone.2017.06.020

By Carol Eustice
Carol Eustice is a writer covering arthritis and chronic illness, who herself has been diagnosed with both rheumatoid arthritis and osteoarthritis.