What You Need to Know About RA and Osteoporosisby Lene Andersen, MSW Patient Advocate
Rheumatoid arthritis (RA), steroids, a sedentary lifestyle, being low on vitamin D — these all are risk factors for developing osteoporosis and may be part of the lives of people with RA. Although being a postmenopausal woman tends to be one of the more familiar risk factors, people of all ages who have RA also experience a higher risk.
What is osteoporosis? What can you do to prevent it? What can you do if you have it?
What is osteoporosis and osteopenia?
Osteoporosis is a condition in which your bones lose density and therefore break more easily — 55 percent of people 50 and over have osteoporosis, and the risk of fractures (broken bones) is higher in women.
Osteoporosis is a silent condition, usually symptom-free until it causes the first fracture. Osteopenia means that although your bones are gradually changing, these changes have not yet progressed to the point of osteoporosis.
Supplements can prevent thinning bones
Vitamin D is an essential tool in helping your body absorb calcium, which builds strong bones. Vitamin D deficiency is associated with RA, which may also affect your ability to absorb calcium. Your doctor might recommend supplementing with calcium and vitamin D to maximize the benefit from these supplements.
Exposure to the sun for short periods of time without sunscreen for about 20 minutes a day can also give you the vitamin D you need.
RA is a risk factor for osteoporosis
Several factors related to RA are responsible for the higher risk of osteoporosis. First is the condition itself. RA is a systemic illness that affects many different systems in the body, including the bones.
Studies have suggested that disease activity, such as higher inflammation, how long you have had RA, and inadequate treatment may be contributing factors in the development of osteoporosis. People with RA have a 25-30-percent-higher risk of fractures related to osteoporosis than the general population.
What you can do: treatment
There are many reasons for you and your doctor to find a treatment that controls your RA. Because of this condition’s systemic nature, getting it under control protects many different parts of your body — your joints, your heart, your lungs, and definitely your bones.
The lower the inflammation is, the healthier your entire body will be. If your current treatment is not suppressing your RA, talk to your doctor about treatment options.
RA lifestyle factors also contribute to osteoporosis risk
Certain factors associated with living with RA also contribute to the increase in osteoporosis risk. These include a sedentary lifestyle.
RA is a progressive condition and untreated, can cause damage to joints, which can lead to varying levels of disability. These difficulties in mobility can lead to an involuntary sedentary lifestyle. The lack of physical activity is not your choice, but a consequence of fatigue, pain, and feeling unwell — all symptoms of RA.
What you can do: exercise
You may be tired of always hearing about the importance of exercise, especially if it’s difficult for you. However, weight-bearing exercise is key to protecting your bones from osteoporosis. This can include dancing, hiking, aerobics, and running. If your RA makes more intense exercises difficult, you can also exercise in water, which has the potential for, at minimum maintaining, where you are, or even improving your bone density.
Steroids, RA, and osteoporosis
RA medications can also be a contributing factor in a higher osteoporosis risk. Some medications can cause weight gain, such as corticosteroids, but it is not just about what you weigh. Steroids also block the functions of cells that form bone, and methotrexate, another drug used to fight RA, can also interfere with your body’s natural way of rebuilding your bones. Treating your RA, while protecting your bones, can be a difficult balance.
What you can do: balance
A number of factors are involved in making decisions about which treatments you should take. If you have trouble finding a medication that works to suppress your RA, steroids can be a valuable tool in keeping you functioning.
As well, methotrexate is often the first course of treatment, as others, such as the biologics, can be expensive. There are ways of managing the risk, so make sure you have a discussion with your rheumatologist about osteoporosis prevention.
Weight gain and osteoporosis
Historically, it was believed that obesity might protect the bones from developing osteoporosis, but more recent research has shown that this is not the case. In fact, the more fat there is in your body — particularly around the waist — the higher the risk of osteoporosis. Being overweight can also increase the amount of fat in your bone marrow, which again increases the risk of developing osteoporosis.
What you can do: managing your weight
When you live with RA, it’s important to eat a healthy, balanced diet. The better the “fuel” you give your body, the healthier it will be in general. If you want to lose weight, try to avoid diets and instead change the way you eat. Approach this gradually to achieve lasting change. Reducing a bit at a time will help — losing just one pound will take four pounds of strain off your knees. You may also want to ask your doctor for a referral to a dietitian for help with food planning.
The primary tool used in testing for osteoporosis is dual-energy X-ray absorptiometry, also called the DXA scan or Dexa-Scan. It is a painless, noninvasive procedure that scans the bones in your pelvis and spine. The results will be provided in a number, indicating your level of bone density. Guidelines recommend DXA scans for women over 65 and men over 70, as well as younger women with additional risk factors. Both men and women with RA should talk to their doctors about getting regular DXA scans as part of preventing osteoporosis.
Other tests can predict and detect osteoporosis
Your doctor can also use the FRAX tool, which is available in either a paper form or online. This tool was developed by the World Health Organization and uses a number of indicators to predict your risk of developing osteoporosis. As well, other imaging tests, such as computerized tomography (CT) scans and ultrasounds can also detect osteoporosis.
Treatment for osteoporosis
Although it’s preferable to prevent osteoporosis, if you do get diagnosed with the condition, there are treatments that can help you build stronger bones.
Supplementing with vitamin D and calcium is essential for both prevention and treatment, but you may also need to take a prescription medication. Which medication will be recommended by your doctor depends on a variety of factors. Bisphosphonates are the most common osteoporosis drugs and work by slowing down the rate of bone resorption.