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Osteoporosis and RA

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By ACCORDANT HEALTH SERVICES

Osteoporosis (ahs-tee-o-pa-ro-sis) means porous bones. Osteoporosis is a disease that causes bones to become weak, brittle, and likely to break. It can affect any bone in the body. The bones most likely to break due to low bone mass are the hip, wrist, and spine. People can get osteoporosis at any age. Eighty percent of those who get it are women.

QUIZ: Take a Guess!
Take this quiz before you read the rest of the chapter. Choose the answers you think are correct. To see if you guessed right, look for the answers as you read. (You will find the quiz answers at the end of the article.)

  1. Which of these increases your risk for osteoporosis?
    • Having RA
    • Playing tennis
    • Getting a bone density test
    • Drinking milk every day
  2. Which of these can help prevent osteoporosis?
    • Taking calcium and vitamin D pills
    • Going for a walk every day
    • Not smoking
    • All of the above
  3. How many fractures are caused by osteoporosis each year in the U.S?
    • 250,000
    • 500,000
    • 1.5 million
    • 3 million
  4. Compared to men, hip fractures occur in women:
    • Half as often
    • Twice as often
    • Just as often
    • Rarely
  5. Which is an early symptom of osteoporosis?
    • Pain
    • Stiffness
    • Falling
    • There are no symptoms.

Bone Basics
Bones are living tissue that is always changing. The cycle of changes is called bone remodeling. In remodeling, old bone is broken down and new bone is made. When new bone is made faster than old bone is broken down, your bones get stronger. But when old bone is broken down faster than new bone is made, bones get weak. This is osteoporosis--a disease that causes1.5 million fractures each year in the U.S. Because it is painless and has no symptoms, many people don't know they have it until they break a bone.

Osteoporosis and RA

People with RA are more likely to get osteoporosis. Here is why:

  1. The disease itself can cause bone loss. Bone loss may be worse right around the joints.
  2. Some people with RA do little or no exercise. If you do not exercise enough, you increase the risk of osteoporosis.
  3. Some medicines for RA lead to bone loss. Methotrexate, a DMARD medicine, can do this. Certain steroid medicines can cause glucocorticoid-induced osteoporosis. Medicines that cause this are:
    • Prednisone (Deltasone®, Orasone®, etc.)
    • Prednisolone (Prelone®)
    • Dexamethasone (Decadron®, Hexadrol®)
    • Cortisone (Cortone Acetate®)
    Up to half of those who take them for a long time break a bone. Most often it is bone in the spine. Women are twice as likely as men to break a hip.

Preventing and Treating Glucocorticoid-induced Osteoporosis
As soon as you begin taking a steroid medicine, you should also take steps to protect your bones. This is important because bone loss happens fastest when you first start the medicine. Talk to your doctor about:

  • Taking as low a dose as possible, for as short a time as possible. The bigger the dose and the longer you take it, the more chance there is for bone loss.
  • Getting a bone mineral density (BMD) test before you start taking medicine. This quick, painless test shows the thickness of your bones. It can predict your chances for fracture. This test may be repeated every six months to see if your bones change while taking a steroid medicine.
  • Reclast® (zoledronic acid) is a medicine that is approved for prevention of osteoporosis in some men and women taking a steroid.

Here is a list of other things that both prevent and treat osteoporosis. Discuss these options with your doctor.

Calcium and vitamin D. People taking steroid medicines need 1,500 mg of calcium every day. To absorb the calcium, your body also needs at least 800 international units (IU) of vitamin D. The best way to be sure you get enough of these is to take pills that contain both. Keep in mind that your body can only absorb 500 mg of calcium at a time. This means you need to take pills at different times throughout the day.

Exercise. Weight bearing exercise strengthens the bones. Weight bearing exercises include walking, running, dancing, skiing, weight lifting, and stair climbing. Activities like bike riding, swimming, and using an elliptical trainer provide a good cardiovascular workout, but they are not weight bearing exercises. They do not make your legs, hips, and spine bear much weight. To strengthen your bones, do at least 30 minutes of weight bearing exercise each day.

Medicines. Medicines like Fosamax®, Actonel,® Boniva®, Evista®, Reclast®, and others can help treat glucocorticoid-induced osteoporosis. For some women who no longer have periods, hormone replacement may also help. Your doctor may suggest other medicines instead of, or in addition to, these.

Getting help. If you struggle with depression or alcoholism, get help. Depression is a major risk factor for osteoporosis. Alcoholism is a big risk factor for osteoporosis for men. Drinking too much alcohol makes it harder for your body to absorb calcium.

Lifestyle changes. If you smoke, quit. Smoking makes it harder for your body to absorb calcium. Caffeine and some soda ingredients may affect your bone health. Do not drink more than three cups of coffee a day and go easy on sodas that contain caffeine.

Preventing Falls. If you have osteoporosis and you fall, you could easily break a bone. Falls often result in the need for nursing home care. Everyone needs a safe home environment that guards against falls.

Here are some tips for preventing falls at home.

  • Change positions slowly to prevent dizziness and/or fainting.
  • Remove all scatter rugs, bath mats or other non-attached carpeting that might be tripped on.
  • Wear good support shoes. Avoid open-toed, high heeled, or crepe-soled shoes.
  • Use nightlights in the bathrooms and hallways.
  • Keep outdoor walkways well lit.
  • Install railings on both sides of all stairs.
  • Install grab bars in bathrooms.
  • Remove doorsills that might be tripped over when entering a room.
  • Look closely at furnishings and knick-knacks. Are there sharp corners or other dangers that could cause injury in the event of a fall? If so, remove or rearrange these items.
  • If need be, arrange to live on the lower level of the house.
  • Use a wheelchair, walker, cane, or other aids like handholds if needed.
  • Install handles on the walls next to the doorknob side of all doors. The handle can be held with one hand while pulling on the knob with the other.
  • Establish an exercise routine. This will improve both muscle and bone strength and reduce the likelihood of injury.
  • Use a chair with a lift for trouble getting into or out of a chair.
  • Keep your doctor informed of all falls even if no injury occurs, so your treatment plan can be changed if necessary.

Quiz Answers

1. A

2. D

3. C

4. B

5. D

References

Guidelines for the management of rheumatoid arthritis: 2002 Update. Arthritis Rheum. 2002;46(2):328-346.

Institute of Arthritis and Musculoskeletal and Skin Diseases. Accessed March 18, 2008.

Mayo Clinic. Accessed March 18, 2008.

National Osteoporosis Foundation; 2005.

Arthritis Foundation. Accessed March 18, 2008.

Last Modified Date: December 28, 2009 © Accordant Health Services, a CVS/Caremark company.   All rights reserved. This article has been reviewed for accuracy by a member of the Accordant Health Services Medical Advisory Team. This information is not intended to be a substitute for professional medical advice. You should not use this information to diagnose or treat a health problem or disease without consulting with a qualified healthcare provider. Please consult your healthcare provider with any questions or concerns you may have regarding your condition. Use of this online service is subject to the disclaimer and the terms and conditions.