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The interplay of rheumatoid arthritis and osteoporosis: exploring the pathogenesis and pharmacological approaches

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Abstract

Rheumatoid arthritis (RA) and osteoporosis are two chronic disorders that are often seen together. RA is an autoimmune disorder that causes pain and inflammation in the joints, while osteoporosis is a disorder in which the bones become weak and fragile. Risk factors for bone loss in RA include disease activity, longer disease duration, erosive disease, autoantibody positivity, and joint damage leading to impaired physical activity. Recent research has shown that there is a complex interplay between immune cells, cytokines, and bone remodeling processes in both RA and osteoporosis. The bone remodeling process is regulated by cytokines and immune system signaling pathways, with osteoclasts activated through the RANK/RANKL/OPG pathway and the Wnt/DKK1/sclerostin pathway. Understanding these mechanisms can aid in developing targeted therapies for treatment of osteoporosis in RA patients. Current pharmacological approaches include anti-osteoporotic drugs such as bisphosphonates, denosumab, teriparatide, abaloparatide, raloxifene, and romosozumab. Conventional disease-modifying antirheumatic drugs such as methotrexate and biologicals including TNF inhibitors, IL-6 inhibitors, rituximab, and abatacept lower disease activity in RA and can improve bone metabolism by reducing inflammation but have limited impact on bone mineral density. This review will shed light on the relationship between osteoporosis and rheumatoid arthritis as well as the various factors that influence the onset of osteoporosis in RA patients. We also explore several treatment approaches to effectively managing osteoporosis in RA patients.

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Acknowledgements

This study was carried out under the Indian Council of Medical Research-Short Term Studentship (ICMR-STS) 2022 program. We acknowledge the support of ICMR-New Delhi and All India Institute of Medical Sciences, Bathinda. We thank NG and NK for writing the manuscript; AA and KK for making all necessary changes and revising the manuscript; AK for editing, revision, and proof reading; and KK and AK for conceptualizing and execution of the study.

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  1. Department of Pharmacology, All India Institute of Medical Sciences, Bathinda, 151001, Punjab, India

    Nikhil Gupta, Anchal Arora & Abhinav Kanwal

  2. Department of Pharmaceutical Sciences and Technology, Maharaja Ranjit Singh Punjab Technical University, Bathinda, 151001, Punjab, India

    Navjot Kanwar

  3. Department of Orthopedics, All India Institute of Medical Sciences, Bathinda, 151001, Punjab, India

    Kavin Khatri

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  1. Nikhil Gupta
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Correspondence to Kavin Khatri or Abhinav Kanwal.

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Gupta, N., Kanwar, N., Arora, A. et al. The interplay of rheumatoid arthritis and osteoporosis: exploring the pathogenesis and pharmacological approaches. Clin Rheumatol 43, 1421–1433 (2024). https://doi.org/10.1007/s10067-024-06932-5

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