- Is there an increased risk of developing osteoporosis if a person has rheumatoid arthritis or any of the rheumatic diseases?
- If yes, what is responsible for the increased risk of osteoporosis?
- Should a person with rheumatic disease be routinely tested (bone density test) for osteoporosis or wait until symptoms develop?
- Should people with rheumatic disease take any action or take any medication to prevent osteoporosis?
There are several reasons for this increased risk:
- Women are more likely to develop rheumatic diseases and also more likely to develop osteoporosis.
- Other risk factors include lack of weight bearing exercise or corticosteroid use.
- A new theory is that the the protein interleukin-1 (IL-1) plays a role in osteoporosis. Rheumatoid arthritis patients have increased levels of IL-1.
Patients at risk for osteoporosis should be offered screening with a dual energy x-ray absorptionmetry or (DEXA). In addition to being a women and having a rheumatic disease, other risk factors include but are not limited to:
- lack of estrogen
- excessive alcohol use
- thin body habitus
- family history of osteoporosis
If osteoporosis is diagnosed, it is essential that patients consume adequate amounts of calcium (1500mg), vitamin D (400-800 IU) as directed by your physician and participate if possible in weight bearing exercise. Additional treatment with bisphosphonates as well as other medications to help prevent or increase bone density should be considered.
Answers provided by Scott J. Zashin, M.D., clinical assistant professor at University of Texas Southwestern Medical School, Division of Rheumatology, in Dallas, Texas. Dr. Zashin is also an attending physician at Presbyterian Hospitals of Dallas and Plano. He is a fellow of the American College of Physicians and the American College of Rheumatology and a member of the American Medical Association. Dr. Zashin is author of Arthritis Without Pain - The Miracle of Anti-TNF Blockers. The book is useful for anyone on one of the biologic drugs (Enbrel, Remicade, Humira) or considering the biologic drugs. Read our review of the book.