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Osteoporosis International
Published in: Osteoporosis International 10/2013

01-10-2013 | Review

Can bone loss in rheumatoid arthritis be prevented?

Authors: M. Vis, M. Güler-Yüksel, W. F. Lems

Published in: Osteoporosis International | Issue 10/2013

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Abstract

Rheumatoid arthritis (RA) is a systemic inflammatory disease that can lead to local joint deformations (bone erosions and joint space narrowing) and to extra-articular phenomena, including generalized osteoporosis. In addition, in patients with RA, the risk of vertebral and nonvertebral fractures is doubled. High disease activity (inflammation), immobility, and glucocorticoid use are common factors that substantially increase fracture risk in these patients, on top of the background fracture risk based on classical risk factors such as high age, low body mass, and female gender. New insights on the links between the immune system and the bone system, the field of osteoimmunology, have shown that local and generalized bone loss share common pathways. The receptor activator of nuclear factor κB ligand/osteoprotegerin pathway (RANKl/OPG) is one of the most important pathways, as it is (strongly) upregulated by inflammation. In modern treatment of RA with biologics, for example, TNFα-blocking agents and combination therapy of conventional disease-modifying antirheumatic drugs (DMARDs), clinical remission is a realistic treatment goal. As a consequence, in recent studies, it has been documented that both local and generalized bone loss is absent or minimal in those patients who are in clinical remission.
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Metadata
Title
Can bone loss in rheumatoid arthritis be prevented?
Authors
M. Vis
M. Güler-Yüksel
W. F. Lems
Publication date
01-10-2013
Publisher
Springer London
Published in
Osteoporosis International / Issue 10/2013
Print ISSN: 0937-941X
Electronic ISSN: 1433-2965
DOI
https://doi.org/10.1007/s00198-013-2334-5

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