Osteoporosis in rheumatoid arthritis.
Osteoporosis is recognised as a common complication of rheumatoid arthritis, with two characteristic patterns--juxta-articular and generalized bone loss. Increasingly sophisticated means of measuring bone turnover and identifying inflammatory mediators which affect bone resorption have enhanced our understanding of the disease process. The aetiology is multifactorial, involving disease-specific and general factors, but the relative importance of the various risks remains uncertain. The evidence for a protective role for oestrogens and the detrimental effect of low dose corticosteroids will be discussed. Biochemical assessment of bone loss lacks sensitivity and specificity, but the rapid improvement in radiological techniques for measuring bone mineral density have improved our ability to diagnose and assess disease progression. The diagnosis and treatment of specific risk factors, such as testosterone or vitamin D deficiency, may be helpful in a few patients, but the ultimate aim must be the early diagnosis and prevention of this potentially catastrophic complication.
Jones
S M
SM
Royal National Hospital for Rheumatic Diseases, Bath, U.K.
Bhalla
A K
AK
D000305:Adrenal Cortex Hormones / Q000009:adverse effects; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications*; D015415:Biomarkers; D015519:Bone Density; D005260:Female; D050723:Fractures, Bone / Q000209:etiology; D006801:Humans; D008875:Middle Aged; D010024:Osteoporosis / Q000209:etiology* / Q000517:prevention & control / Q000628:therapy; D015663:Osteoporosis, Postmenopausal / Q000209:etiology
D000305:Adrenal Cortex Hormones; D015415:Biomarkers