How to Lower Your Osteoporosis Risk When You Have Rheumatoid Arthritis

From everydayhealth.com

Rheumatoid arthritis (RA) is an autoimmune disease that causes swelling, pain, and stiffness in the joints. It can also increase your risk of osteoporosis, making bones fragile and prone to fractures. Some research shows that RA is associated with double the risk of osteoporosis. When you’re diagnosed and being treated for RA, it’s important to make lifestyle and treatment decisions to protect your bones. “I always talk to rheumatoid arthritis patients about the importance of bone health,” says Nilanjana Bose, MD, a rheumatologist who practices in Houston.

How RA Raises the Risk of Osteoporosis

There are several ways in which RA increases the risk of bone loss and osteoporosis. 

Chronic Joint Inflammation

RA causes the release of cytokines, proteins involved in inflammation — which leads to joint damage. But the cytokines also activate osteoclasts, bone cells that break down damaged bone tissue. Typically, the breakdown and build-up of bone is a normal process that keeps bones healthy, but if there are too many osteoclasts, it can lead to bone loss over time.

Use of Steroids to Control Pain and Inflammation

Corticosteroids, like prednisone, are often given to people with osteoarthritis during flares to reduce inflammation, pain, and swelling in joints. But long-term steroid use is a known risk factor in osteoporosis. Steroids increase the breakdown of bone and inhibit the formation of new bone tissue. The risk increases the longer you take steroids and at higher doses.

Lack of Physical Activity Due to Fatigue and Pain

It can be difficult to exercise with painful joints, and sometimes it’s better to rest during a flare to avoid making it worse. But not getting regular physical activity, especially weight-bearing movement, is a known risk factor for osteoporosis.

How to Lower Your Osteoporosis Risk

When you’re diagnosed with RA, it’s important to think about bone health, no matter your age. If you make changes to your lifestyle and choose medications with your bones in mind, it can help lower your risk of osteoporosis. 

Optimize Your RA Treatment to Reduce Inflammation

“Reducing inflammation is the crux of treatment of rheumatoid arthritis for many reasons,” says Dr. Bose. Not only does inflammation contribute to joint pain, stiffness, and damage, it can promote bone loss and other problems. “Systematic inflammation can lead to serious consequences, including heart issues and stroke,” says Bose. Reducing joint inflammation as quickly and effectively as possible can reduce all these risks, she adds. 

Research shows that treatments such as disease-modifying anti-rheumatic drugs (DMARDs) and biologics lower the risk of bone loss in people with RA. “The stronger the medicine, the better it is at reducing downstream effects,” says Bose.

Talk to Your Doctor About Alternatives to Steroids if You Take Them Regularly

Sometimes you may have to take corticosteroids for short periods of time. “We use steroids at the outset when someone presents with active disease to get it under better control faster when we’re starting them on disease-modifying drugs,” says Bose. 

Treatments like DMARDs can take several months to be effective, so steroids provide relief until they kick in. Steroids may also be used during an RA flare. But it’s important to limit your exposure to steroids as much as possible to reduce your risk of bone loss. Taking more than 5 mg a day for more than three months increases the risk. And risk is cumulative, meaning that taking steroids multiple times, even for shorter stretches, adds up.

Talk to your doctor about using corticosteroid injections rather than taking steroids orally. This may limit the effect on bones.

Talk to Your Doctor About Calcium and Vitamin D Supplements

Bones need a healthy dose of calcium and vitamin D to continue to rebuild and maintain their density. Ask your doctor to recommend that daily dose of calcium that’s right for you.

It’s not always easy to get enough calcium through diet so you may need to take a calcium supplement.

Recommended doses of vitamin D vary and levels can be checked with simple blood work, so ask your healthcare provider what dose you need. A vitamin D supplement may help.

Get Regular Weight-Bearing and Muscle-Building Exercise

Weight bearing exercise puts stress on your bones, which triggers bone-building. Exercise is also important for keeping joints flexible. But with joint pain and fatigue, it can be the last thing you want to do. 

Walking is a low-impact activity that’s easy on the joints. Yoga can also be weight bearing, and involves stretching, which can help improve the range of motion in your joints. 

Strength training and weight-bearing exercise is an effective way to build muscle and bone. It may be helpful to work with a personal trainer or physical therapist to make sure you’re not overstressing your joints and to develop a strength-training program that works for you.

Consider Bisphosphonates if You’re at High Risk

When women are diagnosed with osteoporosis, they often take medications like bisphosphonates, which help preserve existing bone and build new bone. Sometimes people with RA, who are at high risk for osteoporosis, are offered these drugs. This may include people taking moderate to high doses of steroids or who are on them for extended periods of time, says Bose. Studies show that bisphosphonates can protect against fractures in people with RA. But bisphosphonates have potential side effects, so be sure to review with your provider if this is an option to protect your bones. 

Should You Be Screened for Osteoporosis?

You may need to be screened for osteoporosis, depending on your age, and if you’ve taken glucocorticoids. 

If you are taking or have taken glucocorticoids, your doctor may recommend a bone density test. The American College of Rheumatology recommends that if you’ve taken glucocorticoids at 2.5 mg or more a day for more than 3 months, and never had a fracture risk assessment, you should be screened. A clinical fracture risk assessment can be performed by your medical provider. If testing is recommended, your provider may recommend bone mineral density testing as soon as possible after starting steroids for adults and every one to two years thereafter if you’re staying on steroids.

The U.S. Preventive Services Task Force (USPSTF) currently recommends that women at average risk for osteoporosis have their first screening at age 65, and that women who are not yet 65 but have risk factors for osteoporosis be screened. Screening for men is not recommended unless they have risk factors. Risk factors include family history of osteoporosis or fracture, frequent falling, vitamin D deficiency, smoking, excessive alcohol intake, and some medications, such as prednisone. Your clinical provider can do a risk assessment; your doctor may recommend screening earlier, depending on the severity of your disease if the inflammation was not well treated for a period of time.

Suggested Screening Tests for Osteoporosis

A couple of tests may be used to screen for osteoporosis.

DEXA Scan A DEXA (dual X-ray absorptiometry) scan measures bone density (thickness and strength of bones) using low-level radiation. A typical screening measures three bones, your ulna (your forearm), your hip, and your spine.

FRAX Calculator This calculates your 10-year risk of having a fracture based on several questions about your health and on your DEXA results. Two of the health questions include having rheumatoid arthritis and taking glucocorticoids.

The Takeaway

• Rheumatoid arthritis (RA) raises your risk of developing osteoporosis due to factors like chronic joint inflammation and the use of corticosteroids. 
• If you have RA, it’s important to pay attention to bone health and talk with your healthcare provider about RA treatments that simultaneously address inflammation and prioritize bone health to lower osteoporosis risk. Newer therapies have shown promise in preventing bone loss, but more research is ongoing.
• If you are currently taking or have taken steroids like prednisone, discuss bone density tests with your doctor, as long-term use is a significant risk factor for osteoporosis.
• Engaging in weight-bearing exercises and considering supplements like calcium and vitamin D can help strengthen bones. But before starting any supplements or new exercise regimens, check in with your doctor.

https://www.everydayhealth.com/rheumatic-conditions/how-to-lower-your-osteoporosis-risk-when-you-have-rheumatoid-arthritis/