Yes, RA can increase your risk of developing osteoporosis and bone fractures. Osteoporosis is a disease of the bones that results in “thinner,” weaker bones that are more prone to fractures. It is a silent disease, however: A person can't feel that his or her bones are getting less dense. Osteoporosis becomes obvious only when the individual suffers a fracture of the hip, wrist, or spine. Osteoporosis-related fractures of the spine, for example, can result in a curvature of the spine called kyphosis (“dowager's hump”). These fractures may or may not be painful, can be disfiguring, and may result in disability and hospitalizations.
Risk factors for developing osteoporosis include the following:
- Family history of the disease
- Thinness or small frame
- Low dietary calcium intake
- Inactivity or lack of exercise
- Smoking
- Excessive alcohol intake
- Prolonged use corticosteroids
- Being postmenopausal and having an early onset of menopause
Medical studies have found that people with RA have an increased risk of bone loss and bone fracture as compared to people of the same sex and age who do not have RA. There are many reasons why people with RA might develop bone loss:
Medical studies have found that people with RA have an increased risk of bone loss and bone fracture as compared to people of the same sex and age who do not have RA. Although there is no cure for osteoporosis, the disease can be managed.
- The inflammation of RA not only causes bone loss at the joints and the areas surrounding the joints, but tends to accelerate bone loss throughout the entire skeleton.
- Women, who are at an increased risk for developing osteoporosis relative to men, are two to three times more likely than men to suffer from rheumatoid arthritis as well.
- Exercise and weight bearing tend to limit bone loss. The inactivity and lack of exercise caused by the pain, stiffness, and fatigue of RA tend to increase bone loss.
- Corticosteroids (also called glucocorticoids—for example, cortisone and prednisone) are often prescribed to decrease inflammation and ease pain. Unfortunately, if they are taken for long periods of time, these medications can cause significant bone loss.
- The pain, fatigue, and stiffness caused by RA can also impair a person's ability to walk and cause an unsteady gait. This may result in falls that can cause fractures.
Despite its “silent nature,” osteoporosis is a disease that can be tested for and treated. As with RA, there is no cure for osteoporosis, but the disease can be managed. The management of osteoporosis is the same for people with RA as it is for those without RA.
To identify the presence of osteoporosis, your doctor can quantify your bone density. The bone densitometry exam or bone mineral density (BMD) test is painless and is typically performed in a doctor's office or the outpatient department of a hospital. It uses low doses of x-rays to examine the bones in your wrist, hip, and spine and to determine whether they are of a normal density or if they show signs of bone loss. Sometimes bone density of the heel is used as a screening test for osteoporosis.
You can reduce your risk of osteoporosis in several ways:
Vitamin D
A fat-soluble vitamin that causes the intestines to increase absorption and metabolism of the minerals calcium and phosphorus (the building blocks of bone).
- Increase the amount of calcium and vitamin D in your diet. Your doctor may recommend calcium and vitamin D supplements in the form of pills.
- Your doctor may wish to measure the level of vitamin D in your blood. If the test shows that this level is low, you can take a supplement to correct this deficiency.
- Increase the amount of exercise you do. Your bones become stronger when they are stimulated by exercise and weight bearing. Of course, you should consult your doctor before starting any new exercise program. Exercise can be avoided when your RA flares up.
- Avoid smoking and excessive alcohol intake.
- If your doctor determines that it is appropriate, he or she may prescribe one of several medications that are indicated for the treatment of osteoporosis. These medications can slow the rate of bone loss and help strengthen your bones.
Patients with RA should discuss their risk for osteoporosis with their primary care physician or rheumatologist. Even minor changes in lifestyle can reduce your risk for bone loss and fractures.