Fractures and Bone Loss

Rheumatoid arthritis (RA) is an autoimmune disease where the body attacks healthy tissue of the joints, cartilage, bone, and organs.1

Studies have found an increased risk of osteoporosis in those with RA. Osteoporosis is a bone disease where the bones become weak and brittle. Osteoporosis causes bones to lose density, becoming weak and more likely to fracture or break.2-4

There are different reasons why RA may be linked to osteoporosis, fractures, and bone loss. Age and gender, medicines, inactivity due to RA pain and stiffness, and inflammation may contribute to this increased risk for bone loss.2,3

Who gets bone loss?

About 54 million Americans have osteoporosis. Women develop osteoporosis more often than men. The condition occurs in nearly 1 out of every 4 women over the age of 65, compared to roughly 5 percent of men the same age.4

Similarly, women are impacted by RA more often than men. RA occurs about 2 to 3 times as often in women than in men. It makes sense that, because of these factors, osteoporosis commonly affects women with RA.1-3,5

This is especially true as women age and reach menopause and postmenopause, when the risk for osteoporosis usually is the highest. Women with RA, who already face a risk of bone loss due to RA inflammation, face an additional increased risk of osteoporosis from menopause. This places these women at high risk for fractures and other complications associated with continued bone loss.1-3,5

Medicines used to treat rheumatoid arthritis

Some drugs used to treat RA can be harmful to the bones. The steroid (glucocorticoid) drugs often prescribed for the treatment of RA can trigger significant bone loss. Steroids work to decrease inflammation in the body. If steroids are taken at high doses or for a long time, bone loss can occur.2,3,5

Do not stop your treatment or change your dose without speaking to your doctor. If you need to take a medicine that may lead to bone loss, your doctor can help you find the best dose for you.5

For people with RA who are receiving steroids, nutritional supplements and additional drugs may be prescribed for those who have osteoporosis. These may include:2

  • Calcium
  • Vitamin D
  • Bisphosphonate (a class of drugs used to prevent bone loss)

Inactivity caused by pain and stiffness

Pain from RA may make you less active. This also increases the risk for bone loss. Also, bone loss in RA may occur as a direct result of inflammation from the disease. The bone loss is most often found in areas around the affected joints.

Reducing your risk for bone loss

Even if you are at a greater risk for bone loss, there are things you can do to reduce your risk:2,3,5-7

  • Stay active. Bone is living tissue and responds to exercise by getting stronger. Weight-bearing exercises, such as walking or hiking, or resistance exercise like lifting weights, can strengthen bone. Talk to your doctor about the activity that is best for you.
  • Eat a well-balanced diet.Nutrition plays an important role in bone health. The first step in preventing osteoporosis and bone loss is increasing calcium and vitamin D. Calcium is a mineral that is essential for bone strength. Vitamin D is needed to help break down calcium and absorb it in the body. You can increase both calcium and vitamin D levels by diet or supplements. 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 bread; and nuts, such as almonds. Talk to your doctor about what supplements you should take.
  • Practice a healthy lifestyle. Smoking and alcohol consumption is harmful to the bones. Both may lead to poor nutrition and increased bone loss.
  • Talk to your doctor. You may need additional tests to check your bone density and monitor your bone loss. Your medicines should not be stopped or changed without talking to your doctor.

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Written by: Jonathan Simmons and Katie Murphy| Last reviewed: January 2021