Rheumatoid Arthritis and Osteoporosis
Osteoporosis affects about eight million women and two million men in America, reports the Missouri Arthritis Rehabilitation Research and Training Center (MARRTC). Over 18 million others have low bone density and are at risk for developing the disease, which is marked by low bone mass, and makes bones brittle and weak. Among them are people who suffer from rheumatoid arthritis.
The link between rheumatoid arthritis and osteoporosis is well established. If you've been living with rheumatoid arthritis from the time you were a child, you're more likely to develop osteoporosis. However, there are many other risk factors for the disease, states the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS):
- Gender (being a woman)
- Having a thin or small frame
- A family history of the disease
- Being postmenopausal or having had an early menopause
- Ethnicity (Asian and Caucasian women are more at risk)
- Amenorrhea, or abnormal absence of menstrual periods
- Low calcium intake
- A sedentary lifestyle
- Excess alcohol consumption
- Prolonged use of some medications, including asthma, lupus, and arthritis medications
Unlike rheumatoid arthritis, osteoporosis doesn't have symptoms until it's progressed for many years. You may not realize you have it until you get a fracture. Some other symptoms include persistent back pain, loss of height, spinal deformities, and kyphosis, which is a severely stooped posture.
Causes of the Rheumatoid Arthritis and Osteoporosis Link
Having rheumatoid arthritis makes you more predisposed to developing osteoporosis for several reasons.
• Disease factors. Pro-inflammatory cytokines, including interleukin-1, interleukin-6 and tumor necrosis factor are elevated when you have rheumatoid arthritis and are associated with bone loss. The disease causes bone loss primarily in the areas around joints, but can also trigger general bone loss as well.
Also, in RA, the immune system attacks the female reproductive system, inhibiting the production of bone-protecting estrogen and other hormones.
• Glucorticoid medications. These effective arthritis medications trigger bone resorption or loss.
• Loss of joint function. The crippling pain associated with arthritis can cause inactivity, which increases the risk of osteoporosis.
How to Avoid the Rheumatoid Arthritis and Osteoporosis Double Whammy
Don't think of osteoporosis as a given when you have rheumatoid arthritis. Instead, actively try to prevent it:
• Get a bone density test. The Arthritis Foundation advises that anyone diagnosed with RA has a bone test, or bone densitometry, as part of their evaluation and monitoring.
• Assess your risk. If you fit into any of the risk categories listed above ( for instance gender, ethnicity or sedentary lifestyle) you should be more proactive about preventing osteoporosis. There's also a simple heel-bone ultrasound test that may assess your risk of osteoporosis.
• Adjust your medications. Speak to your doctor about the risks of osteoporosis from arthritis drugs you're taking. You may need to take your RA drugs in combination with calcium or vitamin D supplements, or bone-protecting drugs such as raloxifene, calcitonin, or risedronate sodium (Actonel®).
• Suppress inflammation. Stay on track with your arthritis medications to minimize inflammation as much as possible.
• Improve your diet. Eat a well-balanced diet rich in calcium, magnesium, potassium and
vitamin K. Also limit your intake of alcohol.
• Get enough sunshine. Your body needs the sun to create vitamin D, which is essential for bone health. Try to get 15 minutes of sunshine before noon or after 2 p.m. Or, take a vitamin D supplement.
• Quit smoking. If cold turkey isn't for you, consider using aids such as the nicotine patch or gum, or ask your doctor about smoking-cessation programs.
• Exercise. Get at least 30 minutes of exercise five days a week, especially weight-bearing exercises, which are great for building healthy bones.
• Maximize bone density. Perhaps the best way to avoid battling both rheumatoid arthritis and osteoporosis is to achieve a high bone mass early in life through diet and exercise.
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