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Rheumatoid arthritis
Rheumatology
Rheumatoid arthritis (RA) is a chronic systemic illness. It affects the whole body, especially the joints. RA is also an autoimmune disease, which means that the immune system in the body, usually responsible for fighting off infections, instead begins to attack healthy tissue.
Inflammation, which is a major feature of rheumatoid arthritis contributes to joint pain and swelling, and cartilage damage, which then leads to erosion into the bone around the joint. Inflammation also affects bones, including contributing to the loss of bone mineralization. Bone mineralization is the ongoing process of absorption of minerals and requires adequate intake of vitamin D, calcium, and other nutrients – including iron, phosphorus, and zinc – which are needed to build and maintain healthy bones. Inflammatory processes in the bone near the joints – as well as in bone erosions and large cysts around the joint – can decrease the mineral content of the bone. This can lead to the development of osteopenia
Osteoporosis
Rheumatology
Osteoporosis is a “silent” skeletal disorder caused by the loss of bone mineral content. It is marked by low bone mass and density, microscopic deterioration within the bone, an increase in bone fragility, and an increased risk of fracture. Osteoporosis occurs when your body makes too little bone (formation), loses too much bone (resorption), or is a combination of both of these factors.
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Normal bone growth cycle
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Bone is living tissue and even as adults, we are constantly remodeling our whole skeleton! In the normal bone growth cycle, our bodies continually:
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make new bone (although less so as we age)
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maintain bone homeostasis (resting bone state)
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remove older fatigued bone
The body tries to replace old bone that it has removed. However, the amount of bone replaced is reduced as we age and in people with certain diseases such as rheumatoid arthritis.
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The good news is that we can do things to make bones healthier, stimulate bone formation and slow down bone remodeling. Bone remodeling is the body’s way of breaking down weak bones and rebuilding stronger bones. At around age 27 to 30, our bones are strongest and at peak mineral density. However, after this age, there is a slow and steady decline in bone strength, accompanied by an increased risk of developing osteopenia and osteoporosis.
Biological risk factors
Rheumatology
The biological risk factors of osteoporosis
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race/gender/age: Caucasian and Asian postmenopausal women over the age of 65; men over the age of 70
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low body mass index or obesity
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small, thin frame
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family history of osteoporosis and/or hip fracture
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diabetes
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hyperthyroidism (Grave’s disease)
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rheumatoid arthritis
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lupus
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renal (kidney) disease
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malabsorption disorders (in which a person's body does not correctly absorb nutrients such as carbohydrates, proteins, fats, vitamins or minerals), for example:
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celiac disease
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irritable bowel disease
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complications or side effects of bariatric surgery
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congenital (since birth) bone and collagen disease
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Although you can’t change the risk factors above, you can have some control over other risk factors. There are several bone-healthy lifestyle choices that can have a significant, positive impact.
How is osteoporosis diagnosed
Rheumatology
Since osteoporosis is a silent disease and is not associated with pain until you fracture a bone, it is important to have screening tests performed to look at the quality or mineralization of the bone.
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Dual-energy X-ray absorptiometry (DEXA or DXA) is a low-dose ionizing radiation X-ray used to measure bone mineral content. Insurance will not pay for a yearly exam. Postmenopausal women are encouraged to have a bone density exam every two years after age 65 or older, as are men age 70 or older. People with risk factors or who have experienced fractures from low-energy activity or falls should begin having DEXA scans at an earlier age.
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Trabecular bone score (TBS), obtained through DEXA imaging, is a diagnostic tool that measures bone architecture and fracture risk.
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Quantitative CT scan: This measures the volume of bone mineral density in the spine. This is another radiology test that can be performed if you have had a CT scan of your lumbar spine. The test looks at the inside quality of the bone within a few vertebral bones in your spine.
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Laboratory bone markers: Look at the rate of a person’s bone formation and loss. We can measure, in both blood and urine tests, bone markers that tell us how much bone your body is making at a certain point in time along with how much bone breakdown is occurring.
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Frax scores: Developed by the World Health Organization (WHO), FRAX Analysis is a risk assessment test that estimates 10-year risk of hip fracture and major fractures overall, based on personal history and other risks.
How are osteoporosis and osteopenia treated
Rheumatology
Once one is diagnosed with osteoporosis or osteopenia, taking calcium alone is not adequate to restore bone density. Discussions with your healthcare provider will likely identify treatment options which include:
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Antiresorptive medications – To decrease bone turnover
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Anabolic medications – To improve the formation of new bone
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Loss of bone mineral density occurs naturally with the normal aging process. Rheumatoid arthritis and its treatment with corticosteroids can increase an individual’s chance of developing a low bone mineral state such as osteopenia or osteoporosis.
Screening tests to identify poor bone mineralization are important along with treatment with medications if indicated. Conservative measures such as diet, supplements, exercises and fall prevention are all important to include in a bone-healthy lifestyle.
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