Ensuring the proper intake of calcium is especially important for women and men with RA, both because the disease itself is associated with bone loss and because long-term glucocorticoid treatment, which many patients with RA depend on for control of inflammation during periods of disease activity, can be associated with bone loss. Women with RA who are near menopause or post-menopausal are at particularly high risk for osteoporosis, which can increase risk of bone fracture.1


RA and increased risk of fracture

The increased risk of fracture with RA has been shown in several studies. A large study conducted in the UK including over 30,000 RA patients and over 90,000 normal non-RA controls found that the RA group had increased risk for fractures of the hip, pelvis, spine, humerus (upper arm), and tibia/fibula (lower leg). The group of RA patients had twice the risk for hip fractures and over twice the risk for fractures of the spine compared with an age-matched group in the general population.2

There is also a definite link between glucocorticoid use and increased risk for fractures in patients with RA. The debate about what constitutes a safe glucocorticoid dose with respect to bone health is still ongoing. Therefore, if you are at increased risk for bone loss, it makes sense to limit your amount of glucocorticoid use, especially since there are other effective RA treatments (DMARDs and biologics) not linked to bone loss. Additionally, for RA patients who are receiving glucocorticoids, calcium supplementation may be important to ensure bone health.3


Getting the calcium you need for bone health

Because RA itself is a risk factor for bone loss (reduced bone mineral density), if you have RA and are above the age of 50 years (for both men and women), you should have your bone mineral density monitored. Bone loss associated with RA occurs as a result of inflammation. Thus, it is important for you to work with your doctor to control the inflammation associated with RA by using one of the many effective treatment options. Treatment with a variety of agents has been shown to slow down or stop damage to joints and related structures.3

If your goal is maintaining bone health, you should make sure that you get the proper amount of calcium in your diet. Common dietary sources of calcium include dairy products, dark green leafy vegetables, calcium-fortified foods and drinks, including orange juice, soy beverages, tofu products, cereal, and breads, as well as nuts, such as almonds. Remember that vitamin D plays an important role in bone health. Your body needs vitamin D in order to absorb calcium (this is why milk is typically fortified with vitamin D). There are few dietary sources of vitamin D. Your body, itself, actually makes vitamin D when it is exposed to sunlight, so make sure you get a proper amount of sun exposure. Check with your doctor to make sure that you have adequate amounts of vitamin D (a simple blood test can tell). Depending on your calcium intake and vitamin D levels, consider taking a calcium supplement with vitamin D for prevention of osteoporosis and fracture. There is some evidence that vitamin D levels may be low in patients with RA due to the RA disease process. In addition to helping with bone health, vitamin D may also have some benefits for immune system function.4,5

Targets for daily calcium intake are 1,000 mg per day for men and women between 25 and 65 years of age and 1,500 mg per day for post-menopausal women. The minimum target for daily vitamin D intake is 400 international units (IU) to prevent health problems such as rickets. The recommended amount of daily or weekly vitamin D intake for RA patients may differ significantly. Check with your doctor to find out how best you can met your personal needs4,6


Recommended calcium intake

Amount (mg/day)
Birth to 6 months
6 months to 1 year
1 to 3 years
4 to 8 years
9 to 13 years
14 to 18 years
19 to 30 years
31 to 50 years
70 years or older
Written by: Jonathan Simmons | Last reviewed: September 2013.
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