Bone metabolism in rheumatoid arthritis compared with postmenopausal osteoporosis.

Abstract

SUMMARY Calcium and bone metabolism in 29 rheumatoid arthritis (RA) patients were compared with those in 27 postmenopausal osteoporotic patients. Signs of vitamin D deficiency were found in 20 RA patients, including 12 who took recommended amounts of vitamin D in their diets and were exposed to sufficient sunlight, and in none of the osteoporotic patients. There were no signs of malabsorption. In six out of 15 patients we found increased liver enzyme activity, which may have a role in vitamin D metabolism. We propose the influence of non-steroidal anti-inflammatory drugs (NSAIDs) on vitamin D metabolism in the liver as a possible explanation.

Vitamin D deficiency does not increase the risk of rheumatoid arthritis: Comment on the article by Merlino et al

“…During the last 3 years, reports in the oromaxillofacial literature on avascular jaw osteonecrosis associated with NGB treatment have increased almost exponentially (5,6). NGBs have proved efficacious in oncology patients with bone involvement, and there is no doubt about the contribution of NGBs in improving the quality of life in patients experiencing bone metastases.…”

“…However, jaw osteonecrosis in patients with osteoporosis who are receiving oral NGBs has repeatedly been reported (5,6). Whether these are isolated examples or are cases that suggest a broader clinical problem will become clearer within the next years.…”

“…Considering the higher life expectancy of patients with osteoporosis compared with that of oncology patients, even lower doses of NGB could lead to the delayed occurrence of jaw osteonecrosis (5). Having said this, how early and aggressively NGBs should be prescribed to patients with osteoporosis might be weighed on an individual basis (8).…”

“…Jaw osteonecrosis represents a severe complication, and currently, no curative treatment exists (5,6). Risk factors for jaw osteonecrosis are an oncologic situation and intravenous rather than oral administration of NGBs.…”

Bone metabolism in patients with rheumatoid arthritis

“…Phosphorus : The data on serum phosphorus concentration differ: they have been reported to be lower than (9), higher than (12) or equal to healthy controls (13,14). The differences, however, are well within the normal range.…”