Rheumatoid Arthritis and Bone Health 

Protecting bone health 

Bone health is an important part of your general health. When the structure of bone becomes weaker and less dense, there is an increased risk of breaking. This is osteoporosis. It can lead to a higher risk of bone breaking from a minor incident (such as a bump, fall or trip). Early diagnosis and management of osteoporosis can help protect bone health and reduce the risk of breaking a bone. 

Rheumatoid arthritis

Rheumatoid arthritis is a particular form of arthritis. It is an auto-immune condition that causes joint pain, swelling and stiffness. There are several reasons why people who have rheumatoid arthritis are at higher risk of developing osteoporosis.  

Inflammation is part of our natural response to germs or harmful substances. In normal circumstances, the heat and redness of inflammation are visible proof that the immune system is working hard to protect the body. In rheumatoid arthritis, the immune system can turn on the body to attack its healthy joints.  The joints become inflamed, and the resulting damage can trigger further inflammation and damage.  Rheumatoid arthritis, which is not controlled, may impact other areas of the body, particularly the bones. The bone surrounding arthritic joints may be weakened by the inflammation occurring nearby. This damage can often be seen on X-rays.  

Natural chemicals released by the body from inflamed joints can circulate the body, weakening other parts of the skeleton and increasing the risk of osteoporosis.  

Joint inflammation can cause pain and difficulty moving. Understandably, having painful and stiff joints can make it difficult to stay active. However, bones need the ‘stress’ of regular exercise to stay strong and healthy. Over time a lack of physical activity may cause your bones to become weaker,  increasing the risk of osteoporosis.  

Steroid medications (glucocorticoids or corticosteroids) are commonly prescribed for rheumatoid arthritis. They are very effective at reducing pain and swelling in the joints. However, it is also well known that steroid medications taken over a long period can lead to bone weakness and increase the risk of osteoporosis. 

Investigating bone health  

For these reasons, people with rheumatoid arthritis should have their bone health investigated and regularly monitored. Your doctor may refer you for a bone density scan. This is because undiagnosed osteoporosis can lead to broken bones. Osteoporosis medication may be prescribed if required to help manage and protect your bone health.

Other common risk factors

Review other common risk factors for osteoporosis. If any risk factors apply to you – discuss these with your doctor.

Personal history

• Previous fracture (from minor bump or fall)
• Family history of osteoporosis (parent/sibling)
• Loss of height (3 cm or more)
• Smoking/Excessive alcohol
• Inadequate calcium, vitamin D or lack of exercise
• Age 70 years and over

Medical conditions

• Coeliac disease
• Diabetes
• Rheumatoid arthritis
• Early menopause/Low testosterone
• Chronic kidney disease or liver disease
• Overactive thyroid or parathyroid

Medications

• Certain treatments for breast cancer
• Certain treatments for prostate cancer
• Glucocorticoids (steroids)
• Anti-epilepsy treatment

Calcium, Vitamin D, Exercise

Take simple steps to help support your bone health.

Focus On	Recommended
Calcium	• 1,000 mg per day from the diet • Increasing to 1,300 mg for women over 50 years and men over 70 years • If dietary intake is low a supplement may be required
Vitamin D	• Limited sun exposure – in summer, a few minutes per day, in winter slightly longer • Avoid UV index above 3 • If vitamin D deficiency is confirmed by your doctor, a supplement may be required
Exercise	• Specific mix of weight bearing, resistance training and balance exercises