Pharmacological Management of Osteoporosis in Rheumatoid Arthritis Patients: A Review of the Literature and Practical Guide

Abstract

Rheumatoid arthritis (RA) is a chronic disabling disease that is associated with increased localized and generalized osteoporosis (OP). Previous studies estimated that approximately one-third of the RA population experience bone loss. Moreover, RA patients suffer from a doubled fracture incidence depending on several clinical factors, such as disease severity, age, glucocorticoid (GC) use, and immobility. As OP fractures are related to impaired quality of life and increased mortality rates, OP has an enormous impact on global health status. Therefore, there is an urgent need for a holistic approach in daily clinical practice. In other words, both OP-and RA-related factors should be taken into account in treatment guidelines for OP in RA. First, to determine the actual fracture risk, dual-energy X-ray absorptiometry (DXA), including vertebral fracture assessment (VFA) and calculation of the 10-year fracture risk with FRAX ® , should be performed. In case of high fracture risk, calcium and vitamin D should be supplemented alongside anti-osteoporotic treatment. Importantly, RA treatment should be optimal, aiming at low disease activity or remission. Moreover, GC treatment should be at the lowest possible dose. In this way, good fracture risk management will lead to fracture risk reduction in RA patients. This review provides a practical guide for clinicians regarding pharmacological treatment options in RA patients with OP, taking into account both osteoporotic-related factors and factors related to RA.

Patterns and Related Influencing Factors of Multiple Chronic Diseases Among the Elderly Based on Data Mining in Shanxi, China

“…Rheumatism or rheumatoid arthritis was a chronic disabling disease that was associated with increased localized and generalized osteoporosis [27]. This study also found association rules between coronary heart disease and atherosclerosis, suggesting that elderly people with atherosclerosis should screen for coronary heart disease as early as possible to reduce their incidence.…”

Incidence and Complication Rates for Total Hip Arthroplasty in Rheumatoid Arthritis: A Systematic Review and Meta-Analysis Across Four Decades

“…However, incidence rates are a reflection of the proportion of patients requiring THA, and not the absolute operative volume. Additionally, if THA is interpreted as an indicator of disease severity [1,4], and complications are a potential result of disease severity [90,91,[92][93][94], this would explain the higher rates of complications in the places with higher incidence rates. An alternative explanation for the variation in complication rates might be that the demographics of patients considered for surgery differs between each of these continents.…”

Osteoporosis in Rheumatoid Arthritis: Dangerous Liaisons

“…On the other hand, the prevalence of OP in RA is around 30% (up to 50% in post-menopausal women), which might be a twofold increase over the general population (6,7). Furthermore, RA patients can experience fractures with higher bone mineral density (BMD) compared to patients without RA (8). In a meta-analysis, the incidence of fragility fractures in RA and general population were 33.00 and 15.31 per 1,000 person-years, respectively (9).…”