Osteoporosis evaluation and treatment recommendations in rheumatoid arthritis

Wysham, Katherine D; Baker, Joshua F.; Narla, Radhika

doi:10.1016/j.berh.2022.101757

Cited by 5 publications

(7 citation statements)

References 59 publications

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“…While TBS values were similar in a small cohort of SSc patients, systematic coupling of VFA with BMD allowed the diagnosis previously unknown asymptomatic vertebral fractures [11]. Other imaging methods have been used in chronic inflammatory disease to assess bone deficits and independently predict fracture risk, such as quantitative ultrasound or peripheral quantitative computed tomography, however, these approaches are not currently accepted as routine screening tests [12].…”

Section: Bone Health Screeningmentioning

confidence: 99%

“…There are no specific guidelines for DXA in SSc, however the recommendations for individuals with rheumatoid arthritis (RA), a more common rheumatic disease, can provide some guidance, with a recommendation to screen all patients over age 50 [12]. Both high daily and cumulative glucocorticoid (GC) doses increase risk of fracture, particularly vertebral fracture, due to the greater effects of GCs on trabecular bone than on cortical bone.…”

Section: Bone Health Screeningmentioning

confidence: 99%

“…The initial basic bone health laboratory testing should consist of complete blood count (CBC), serum calcium, phosphorus, creatinine with estimated glomerular filtration rate (eGFR), 24 h urinary calcium and creatinine excretion panel, hepatic function tests (including a gamma-glutamyl transferase, if the alkaline phosphatase is elevated), thyroid stimulating hormone, parathyroid hormone, and serum 25-OH-D [12]. If a decreased serum albumin is detected in the screening assessment, additional studies can include serum protein electrophoresis, quantitative immunoglobulins with serum free light chains, and stool alpha-1 antitrypsin [12,15]. If malabsorption is suspected, hydrogen breath testing can be useful for the diagnosis of small intestinal bacterial overgrowth (SIBO) as many patients with this complication may suffer from nutritional deficiencies and osteoporosis.…”

Section: Laboratory Assessmentmentioning

confidence: 99%

“…The correct threshold for vitamin D replacement is debated due to differences in prior study designs, analysis, and randomized controlled trials. However, in RA the recommendation is to achieve 25-OH vitamin D level greater than 25 ng/ml to prevent hypocalcemia, especially in patients with chronic kidney disease receiving potent anti-resorptive drugs [12].…”

Section: Calcium and Vitamin Dmentioning

confidence: 99%

“…Calcinosis in SSc is associated with acro-osteolysis, digital ulceration, and osteoporosis, suggesting a link to severe vasculopathy [12]. Dystrophic soft-tissue calcification occurs in damaged or devitalized tissues in the presence of normal calcium/phosphorus metabolism and normal serum calcium and phosphorus levels [28].…”

Section: Calcium and Vitamin Dmentioning

confidence: 99%

See 4 more Smart Citations

Important Considerations for Bone Health Management in Systemic Sclerosis Patients

E. Frech,

Adeogun,

Chew

et al. 2023

Systemic Sclerosis - Recent Advances and New Perspectives

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Bone health in systemic sclerosis (SSc) is an essential management consideration for rheumatologists caring for these patients. Screening for reduction in bone density includes a detailed health history, which includes SSc disease features such as intestinal malabsorption, patulous esophagus, and calcinosis. The established International Society for Clinical Densitometry (ISCD) guidelines provide an official position statement on important topics in skeletal assessment. Bone health laboratory testing are indicated in all SSc patients, especially if a low serum albumin or vitamin deficiencies are detected. Bone health treatment considerations include adequate weight bearing exercise, calcium, and vitamin D in all SSc patients. The key findings of this chapter is that SSc patients are at increased risk for low bone density and comorbidities may affect choice of treatment such as oral bisphosphonates in SSc patients with significant esophageal disease or renal impairment and osteoanabolic therapies in SSc patients with calcinosis are important.

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Section: Bone Health Screeningmentioning

confidence: 99%

Section: Bone Health Screeningmentioning

confidence: 99%

Section: Laboratory Assessmentmentioning

confidence: 99%

Section: Calcium and Vitamin Dmentioning

confidence: 99%

Section: Calcium and Vitamin Dmentioning

confidence: 99%

See 3 more Smart Citations

Important Considerations for Bone Health Management in Systemic Sclerosis Patients

E. Frech,

Adeogun,

Chew

et al. 2023

Systemic Sclerosis - Recent Advances and New Perspectives

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Pathophysiology, diagnosis, and herbal medicine-based therapeutic implication of rheumatoid arthritis: an overview

Kaur,

Mishra,

Kumar

et al. 2024

Inflammopharmacol

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Rheumatoid arthritis (RA) stands as an autoimmune disorder characterized by chronic joint inflammation, resulting in profound physiological alterations within the body. Affecting approximately 0.4–1.3% of the global population, this condition poses significant challenges as current therapeutic approaches primarily offer symptomatic relief, with the prospect of complete recovery remaining elusive. This review delves into the contemporary advancements in understanding the pathophysiology, diagnosis, and the therapeutic potential of herbal medicine in managing RA. Notably, early diagnosis during the initial stages emerges as the pivotal determinant for successful recovery post-treatment. Utilizing tools such as Magnetic Resonance Imaging (MRI), anti-citrullinated peptide antibody markers, and radiography proves crucial in pinpointing the diagnosis of RA with precision. Unveiling the intricate pathophysiological mechanisms of RA has paved the way for innovative therapeutic interventions, incorporating plant extracts and isolated phytoconstituents. In the realm of pharmacological therapy for RA, specific disease-modifying antirheumatic drugs have showcased commendable efficacy. However, this conventional approach is not without its drawbacks, as it is often associated with various side effects. The integration of methodological strategies, encompassing both pharmacological and plant-based herbal therapies, presents a promising avenue for achieving substantive recovery. This integrated approach not only addresses the symptoms but also strives to tackle the underlying causes of RA, fostering a more comprehensive and sustainable path towards healing. Graphic abstract

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Osteoporosis and fragility fractures – Why is there still avoidable disability and death?

Åkesson

Woolf

2022

Best Practice & Research Clinical Rheumatology

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Osteoporosis evaluation and treatment recommendations in rheumatoid arthritis

Cited by 5 publications

References 59 publications

Important Considerations for Bone Health Management in Systemic Sclerosis Patients

Important Considerations for Bone Health Management in Systemic Sclerosis Patients

Pathophysiology, diagnosis, and herbal medicine-based therapeutic implication of rheumatoid arthritis: an overview

Osteoporosis and fragility fractures – Why is there still avoidable disability and death?

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