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Review
. 2021 Aug 28;13(8):e17519.
doi: 10.7759/cureus.17519. eCollection 2021 Aug.

The Impact of Rheumatoid Arthritis on Bone Loss: Links to Osteoporosis and Osteopenia

Roaa Kareem  1 , Rinky A Botleroo  2 , Renu Bhandari  1   3 , Opemipo D Ogeyingbo  1   4   5 , Rowan Ahmed  1 , Mallika Gyawali  1 , Nanditha Venkatesan  6   1 , Abeer O Elshaikh  1
Affiliations
Review

The Impact of Rheumatoid Arthritis on Bone Loss: Links to Osteoporosis and Osteopenia

Roaa Kareem et al. Cureus. .

Abstract

Rheumatoid arthritis (RA) is an autoimmune chronic connective tissue disease that produces persistent systemic inflammation, with joint inflammation leading to function loss and joint destruction. Low bone mass causes skeletal bone loss, commonly referred to as osteopenia or osteoporosis. We conducted this literature review to examine the relationship between RA and osteoporosis and the variables contributing to this connection. We used articles from the US National Library of Medicine (PubMed), Google Scholar, Science Direct to access the required information. Eventually, our results concluded that RA could result in local periarticular and generalized bone loss. Many risk factors contribute to this association, such as chronic joints inflammation, glucocorticoid use, genetics, and estrogen hormone effects. Still, it is not clear yet whether this is due to a consequence of treatment, immobility, or the activity of the disease. There are many recommendations by the American College of Rheumatology for RA patients during the disease course to reduce the risk of osteoporosis development, which include early starts of disease-modifying anti-inflammatory drugs (DMARDs), doing a dual-energy x-ray (DXA) or quantitative ultrasound (QUS) for identifying a patient at risk of osteoporosis, taking vitamin D, calcium, and bisphosphonates. Further prospective studies and clinical trials are essential to provide a solid evidence-based recommendation that will help to prevent bone loss in RA patients.

Keywords: bone loss; fracture prevention; osteopenia; osteoporosis; prevention of osteoporosis; rheumatoid arthriitis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Effect of chronic joint inflammation on bone loss
IL-6: interleukins 6; IL-10: interleukins 10; CRP: C reactive protein; MMP-3: Matrix metalloproteinase-3
Figure 2
Figure 2. Risk factors for osteoporosis development in rheumatoid arthritis patients
RA: rheumatoid arthritis; DMARDs: disease-modifying anti-rheumatology drugs
See this image and copyright information in PMC

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