Doctor...Tell me about rheumatoid arthritis and osteoporosis

Rheumatoid arthritis (RA) is the most common form of inflammatory arthritis. There is some evidence that the disease itself can lead to bone loss.  Some scientific basis is found by examining the role of the abnormal chemical messengers (cytokines) produced by cells in patients with rheumatoid arthritis. An example is tumor necrosis factor, a cytokine that is not only responsible for much of the inflammation in RA but which also can be a potent stimulator of bone loss.

Since RA tends to affect more women than men, there is the hormonal influence that comes into effect after menopause for the aggravation of bone loss.

The effects of drug therapy also are important.  Prednisone, a corticosteroid, is often used to treat rheumatoid arthritis.  It is a potent cause of bone loss.  Some data implicates methotrexate, another drug used to treat RA, as a possible contributing factor.

Because patients with RA tend to find it difficult to exercise, the loss of muscle mass as well as the deleterious effect of inactivity can worsen bone loss.

So what can people do?

For patients with RA     who are receiving prednisone in a dose of 5 mgs or greater, the following are helpful suggestions:

1. Stop smoking
2. Reduce alcohol consumption
3. Begin a weight-bearing physical exercise program
4. Start calcium and vitamin D.  Current dosing recommendations include calcium 1,500 mgs per day and vitamin D 400-800 units per day
5. Consider anti-resorptive drug therapy if bone density testing shows a T-score of-1 or lower
6. Try to reduce the prednisone to the lowest possible dose