Skip to main content
SpringerLink
Log in

Strategies for the Prevention and Treatment of Osteoporosis in Patients with Rheumatoid Arthritis

  • Leading Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Rheumatoid arthritis (RA) is a chronic disease that affects millions of patients worldwide. As better therapies emerge for treatment of this condition, patients with RA are living longer and are more likely to experience diseases associated with aging such as osteoporosis. The aetiology of osteoporosis in patients with RA is multifactorial, with some bone loss attributable to the underlying inflammatory disease. Patients may also experience bone loss that is a consequence of therapy with corticosteroids. Progress in the diagnosis and evaluation of osteoporosis has led to a greater awareness of this major health problem. There have also been many advances in our understanding of the pathophysiology of RA. However, recent studies have suggested that, despite our growing understanding of these diseases, therapies for preventing bone loss in this patient population are underutilised. Patients with RA, especially those taking corticosteroids or with persistent disease activity, must have their bone mass assessed with bone mineral density testing. RA patients with documented osteoporosis or those at high risk for the development of this potentially devastating complication should receive calcium and vitamin D supplementation as well as an anti-resorptive agent.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Nanes MS. Tumor necrosis factor-alpha: molecular and cellular mechanisms in skeletal pathology. Gene 2003; 321: 1–15

    Article  PubMed  CAS  Google Scholar 

  2. Sinigaglia L, Nervetti A, Mela Q, et al. A multicenter cross sectional study on bone mineral density in rheumatoid arthritis. Italian Study Group on Bone Mass in Rheumatoid Arthritis. J Rheumatol 2000; 27(11): 2582–9

    PubMed  CAS  Google Scholar 

  3. Haugeberg G, Uhlig T, Falch JA, et al. Bone mineral density and frequency of osteoporosis in female patients with rheumatoid arthritis: results from 394 patients in the Oslo County Rheumatoid Arthritis Register. Arthritis Rheum 2000; 43: 522–30

    Article  PubMed  CAS  Google Scholar 

  4. Haugeberg G, Ørstavik RE, Uhlig T, et al. Clinical decision rules in rheumatoid arthritis: do they identify patients at high risk for osteoporosis? Testing clinical criteria in a population based cohort of patients with rheumatoid arthritis recruited from the Oslo Rheumatoid Arthritis Register. Ann Rheum Dis 2002; 61: 1085–9

    Article  PubMed  CAS  Google Scholar 

  5. Orwoll E, Bevan L, Phipps KR. Determinants of bone mineral density in older men. Osteoporos Int 2000; 11(10): 815–21

    Article  PubMed  CAS  Google Scholar 

  6. Verhoeven A, Boers M. Limited bone loss due to corticosteroids: a systematic review of prospective studies in rheumatoid arthritis and other diseases. J Rheumatol 1997; 24: 1495–503

    PubMed  CAS  Google Scholar 

  7. Lukert B, Raisz LG. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med 1990; 112: 352–64

    PubMed  CAS  Google Scholar 

  8. Forslind K, Keller C, Svensson B, et al. Reduced bone mineral density in early rheumatoid arthritis is associated with radiological joint damage at baseline and after 2 years in women. J Rheumatol 2003; 30(12): 2590–6

    PubMed  Google Scholar 

  9. D’Elia HF, Larsen A, Mattsson LA, et al. Influence of hormone replacement therapy on disease progression and bone mineral density in rheumatoid arthritis. J Rheumatol 2003; 30(7): 1456–63

    PubMed  Google Scholar 

  10. Gravallese E, Manning C, Tsay A, et al. Synovial tissue in rheumatoid arthritis is a source of osteoclast differentiation factor. Arthritis Rheum 2000; 43: 250–8

    Article  PubMed  CAS  Google Scholar 

  11. Solomon D, Katz J, Jacobs J, et al. Management of glucocorticoid-induced osteoporosis in patients with rheumatoid arthritis: rates and predictors of care in an academic rheumatology practice. Arthritis Rheum 2002; 46(12): 3136–42

    Article  PubMed  Google Scholar 

  12. Solomon D, Katz J, La Tourette A, et al. Multifaceted intervention to improve rheumatologists’ management of glucocorticoid-induced osteoporosis: a randomized controlled trial. Arthritis Rheum 2004; 51(3): 383–7

    Article  PubMed  CAS  Google Scholar 

  13. Gass M, Dawson-Hughes B. Preventing osteoporosis-related fractures: an overview. Am J Med 2006; 119 (4 Suppl. 1): S3–S11

    Article  PubMed  Google Scholar 

  14. Sawka AM, Boulos P, Beattie K, et al. Do hip protectors decrease the risk of hip fracture in institutional and community-dwelling elderly? A systematic review and meta-analysis of randomized controlled trials. Osteoporos Int 2005; 16(12): 1461–74

    Article  PubMed  Google Scholar 

  15. Jamison M, Neuberger GB, Miller PA. Correlates of falls and fear of falling among adults with rheumatoid arthritis. Arthritis Rheum 2003; 49(5): 673–80

    Article  PubMed  Google Scholar 

  16. van Staa TP, Leufkens HG, Abenhaim L, et al. Oral corticosteroids and fracture risk: relationship to daily and cumulative doses. Rheumatology (Oxford) 2000; 39(12): 1383–9

    Article  Google Scholar 

  17. Lodder MC, de Jong Z, Kostense PJ, et al. Bone mineral density in patients with rheumatoid arthritis: relation between disease severity and low bone mineral density. Ann Rheum Dis 2004; 63(12): 1576–80

    Article  PubMed  CAS  Google Scholar 

  18. Dolan AL, Moniz C, Abraha H, et al. Does active treatment of rheumatoid arthritis limit disease-associated bone loss? Rheumatology 2002; 41: 1047–51

    Article  PubMed  CAS  Google Scholar 

  19. Haugeberg G, Strand A, Kvien TK, et al. Reduced loss of hand bone density with prednisolone in early rheumatoid arthritis: results from a randomized placebo-controlled trial. Arch Intern Med 2005; 165(11): 1293–7

    Article  PubMed  Google Scholar 

  20. Seriolo B, Paolino S, Sulli A, et al. Bone metabolism changes during anti-TNF-alpha therapy in patients with active rheumatoid arthritis. Ann N Y Acad Sci 2006; 1069: 420–7

    Article  PubMed  CAS  Google Scholar 

  21. Lange U, Teichmann J, Muller-Ladner U, et al. Increase in bone mineral density of patients with rheumatoid arthritis treated with anti-TNF-alpha antibody: a prospective open-label pilot study. Rheumatology (Oxford) 2005; 44(12): 1546–8

    Article  CAS  Google Scholar 

  22. di Munno O, Mazzantini M, Sinigaglia L, et al. Effect of low dose methotrexate on bone density in women with rheumatoid arthritis: results from a multicenter cross-sectional study. J Rheumatol 2004; 31: 1305–9

    PubMed  Google Scholar 

  23. Bonaiuti D, Shea B, Iovine R, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2002 (3): CD000333

    Google Scholar 

  24. De Jong Z, Munneke M, Zwinderman AH, et al. Is a long-term high-intensity exercise program effective and safe in patients with rheumatoid arthritis? Results of a randomized controlled trial. Arthritis Rheum 2003; 48(9): 2415–24

    Article  PubMed  Google Scholar 

  25. Ottawa Panel evidence-based clinical practice guidelines for therapeutic exercises in the management of rheumatoid arthritis in adults. Phys Ther 2004; 84(10): 934–72

    Google Scholar 

  26. Wood RJ, Serfaty-Lacrosniere C. Gastric acidity, atrophic gastritis, and calcium absorption. Nutr Rev 1992; 50(2): 33–40

    Article  PubMed  CAS  Google Scholar 

  27. Hanley DA, Davison KS. Vitamin D insufficiency in North America. J Nutr 2005; 135(2): 332–7

    PubMed  CAS  Google Scholar 

  28. Hall GM, Daniels M, Doyle DV, et al. Effect of hormone replacement therapy on bone mass in rheumatoid arthritis patients treated with and without steroids. Arthritis Rheum 1994; 37: 1499–505

    Article  PubMed  CAS  Google Scholar 

  29. Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. JAMA 1999; 282(7): 637–45

    Article  PubMed  CAS  Google Scholar 

  30. Vogel VG, Costantino JP, Wickerham DL, et al. Effects of tamoxifen vs raloxifene on the risk of developing invasive breast cancer and other disease outcomes: the NSABP Study of Tamoxifen and Raloxifene (STAR) P-2 trial. JAMA 2006; 295(23): 2727–41

    Article  PubMed  CAS  Google Scholar 

  31. Cummings SR, Eckert S, Krueger KA, et al. The effect of raloxifene on risk of breast cancer in postmenopausal women: results from the MORE randomized trial. Multiple Outcomes of Raloxifene Evaluation. JAMA 1999; 281(23): 2189–97

    Article  PubMed  CAS  Google Scholar 

  32. Delmas PD, Bjarnason NH, Mitlak BH, et al. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med 1997; 337(23): 1641–7

    Article  PubMed  CAS  Google Scholar 

  33. Warren MP. A comparative review of the risks and benefits of hormone replacement therapy regimens. Am J Obstet Gynecol 2004; 190(4): 1141–67

    Article  PubMed  CAS  Google Scholar 

  34. MacDonald AG, Murphy EA, Capell HA, et al. Effects of hormone replacement therapy in rheumatoid arthritis: a double blind placebo-controlled study. Ann Rheum Dis 1994; 53: 54–7

    Article  PubMed  CAS  Google Scholar 

  35. Hock JM, Gera I. Effects of continuous and intermittent administration and inhibition of resorption on the anabolic response of bone to parathyroid hormone. J Bone Miner Res 1992; 7(1): 65–72

    Article  PubMed  CAS  Google Scholar 

  36. Neer RM, Arnaud CD, Zanchetta JR, et al. Effect of parathyroid hormone (1–34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med 2001; 344(19): 1434–41

    Article  PubMed  CAS  Google Scholar 

  37. Rehman Q, Lang TF, Arnaud CD, et al. Daily treatment with parathyroid hormone is associated with an increase in vertebral cross-sectional area in postmenopausal women with glucocorticoid-induced osteoporosis. Osteoporos Int 2003; 14(1): 77–81

    Article  PubMed  CAS  Google Scholar 

  38. Knopp JA, Diner BM, Blitz M, et al. Calcitonin for treating acute pain of osteoporotic vertebral compression fractures: a systematic review of randomized, controlled trials. Osteoporos Int 2005; 16(10): 1281–90

    Article  PubMed  CAS  Google Scholar 

  39. Chesnut CH III, Silverman S, Andriano K, et al. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the Prevent Recurrence Of Osteoporotic Fractures Study. PROOF Study Group. Am J Med 2000; 109(4): 267–76

    Article  PubMed  CAS  Google Scholar 

  40. Sileghem A, Geusens P, Dequeker J. Intranasal calcitonin for the prevention of bone erosion and bone loss in rheumatoid arthritis. Ann Rheum Dis 1992; 51(6): 761–4

    Article  PubMed  CAS  Google Scholar 

  41. Kotaniemi A, Piirainen H, Paimela L, et al. Is continuous intranasal salmon calcitonin effective in treating axial bone loss in patients with active rheumatoid arthritis receiving low dose glucocorticoid therapy? J Rheumatol 1996; 23(11): 1875–9

    PubMed  CAS  Google Scholar 

  42. Russell R, Rogers MJ. Bisphosphonates: from the laboratory to the clinic and back again. Bone 1999; 25: 97–106

    Article  PubMed  CAS  Google Scholar 

  43. Hochberg M, Prashker MJ, Greenwald M, et al. Recommendations for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheum 1996; 39(11): 1791–801

    Article  Google Scholar 

  44. Eastell R, Reid DM, Compston J, et al. A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med 1998; 244: 271–92

    Article  PubMed  CAS  Google Scholar 

  45. Naganathan V, Jones G, Nash P, et al. Vertebral fracture risk with long-term corticosteroid therapy: prevalence and relation of age, bone density, and corticosteroid use. Arch Intern Med 2000; 161: 1780–1

    Google Scholar 

  46. de Groen P, Lubbe DF, Hirsch LJ, et al. Esophagitis associated with the use of alendronate. N Engl J Med 1996; 335: 1016–21

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript. The authors have no conflicts of interest that are directly relevant to the content of this manuscript.

Author information

Authors and Affiliations

  1. Brigham and Women’s Hospital, 75 Francis Street, Boston, Massachusetts, 02115, USA

    Kristine Phillips, Antonios Aliprantis &  Jonathan Coblyn

Authors
  1. Kristine Phillips
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Antonios Aliprantis
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Jonathan Coblyn
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Jonathan Coblyn.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Phillips, K., Aliprantis, A. & Coblyn, J. Strategies for the Prevention and Treatment of Osteoporosis in Patients with Rheumatoid Arthritis. Drugs Aging 23, 773–779 (2006). https://doi.org/10.2165/00002512-200623100-00001

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-200623100-00001

Keywords

Search

Navigation