Osteoporosis in rheumatoid arthritis

Journal/Book: Z Rheumatol 1998; 57 Suppl. 1: 3 (H 8). 1998;

Abstract: Arthritis and Metabolic Bone Disease Research Unit. K. U. Leuven; Division of Rheumatology U. Z. Pellenberg Objective. To answer and comment on a number of controversial issues in relation to osteoporosis and rheumatoid arthritis (RA) including: Is osteoporosis an extra-articular manifestation of rheumatoid arthritis? Does periarticular osteoporosis reflects disease activity in early arthritis? Is there a threshold for corticosteroid-induced osteoporosis? Can anti-resorbing drugs prevent rheumatoid arthritis progression? Are stress fractures rare in rheumatoid arthritis? Is methotrexate toxic for bone? Methods. Confrontation of current literature and our own experience in order to formulate a general opinion. Results and conclusions. Because most studies agree that osteoporosis in postmenopausal women and in men with RA is more evident at the hip and radius than at the spine and that the most important determinants of bone loss are disability local disease activity and cumulative corticosteroid dose osteoporosis is not a common systemic extra-articular manifestation of RA. In early arthritis periarticular osteoporosis does indeed reflect disease activity because it is closely related to the acute phase reactants but once periarticular osteoporosis is established it is no longer a marker of disease activity. The threshold dose for corticosteroid-induced osteoporotic fractures is the cumulative rather than the actual dose. Statements based on quantitative tomography concerning the acute effects (and their reversal) of corticosteroids on bone have to be interpreted with care because of important body composition changes in particular in bone marrow fat during corticosteroid treatment. At present there is no evidence that anti-resorbing drugs can change the progress of RA erosions probably because erosions are the result of non-osteoclast mediated mechanisms. Stress fractures in RA are underdiagnosed and are often confused with synovitis and therefore it is likely that they are more frequent than commonly thought in particular at the lower limbs. le

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