Rheumatoid arthritis and its treatments can increase your risk for developing osteoporosis. Learn ways to prevent bone loss and the fractures it can cause.

People with rheumatoid arthritis (RA) aren’t just at risk for damaged joints — they’re also more likely than their peers without RA to develop osteoporosis, a condition characterized by bone loss and a high risk for fractures. That’s the preliminary finding of a recent study from the Mayo Clinic, where researchers compared fracture rates among two groups of 1,155 people each, one group with RA and one without.

Fractures were more likely in both women and men with RA than in those without the condition. Women were more likely to have a first fracture before age 50.

There are many reasons why you might develop osteoporosis as a side effect of rheumatoid arthritis. Steroid medications, like prednisone, that are commonly used for RA can negatively affect bone cells, change the way your body uses calcium, and lower your bone mass.

Inflammation caused by rheumatoid arthritis can also be to blame. “It may have to do with cells called cytokines that occur with inflammation and impact the bones,” says Robert Shmerling, MD, clinical chief of rheumatology at Beth Israel Deaconess Hospital in Boston. And then there’s the gender factor — already at an increased risk for osteoporosis, women develop RA two to three times more than men.

Osteoporosis: A Silent Disease

Unlike the crippling pain of RA , osteoporosis can be hard to detect in its early stages. But when one or more vertebrae in the spine collapse and cause severe back pain, a stooped posture, and reduced height, these are all signs of osteoporosis. Since there is no cure for osteoporosis, your best plan is to try to prevent it. And if you have rheumatoid arthritis, the following steps are particularly important to protect your bones from damage.

• Evaluate your steroid dose. If you take steroid medications to control your RA symptoms, talk with your doctor about the possibility of discontinuing them or reducing the dosage or frequency. “There are patients who take higher doses of prednisone and have not tried to reduce it in a long time,” Shmerling says. “It’s hard to know whether they really need that much.” Newer “disease-modifying” drugs like methotrexate and biologic agents such as adilumamab can help control RA symptoms without the osteoporosis risk caused by steroids. Non-steroidal anti-inflammatory drugs, or NSAIDs, such as ibuprofen, may also help with pain relief.
• Take your vitamins. Calcium and vitamin D both promote good bone health. However, it’s rare that you can get all you need just from diet, Shmerling says. An over-the-counter supplement can help boost your calcium and vitamin D intake. Adults age 31 to 50 need 1,000 milligrams (mg) of calcium and 600 mg of vitamin D each day; after 50, women should start getting 1,200 mg of calcium daily. Make sure to read the labels on your supplements so you know exactly how much calcium and vitamin D is contained in each tablet. For extra insurance, load up on calcium- and vitamin D-rich foods like low-fat yogurt, fat-free milk, spinach, and salmon, and be sure to eat them every day.
• Exercise. Adequate physical activity doesn’t just make you feel good, it also promotes strong bones. “Weight-bearing exercise in particular is a good way to maintain bone strength,” Shmerling says. Walking, jogging, gardening, and weight training are some examples of weight-bearing activities. Aim for at least 30 minutes a day of moderate exercise, plus strength-training activities two to three times a week.
• Cut out smoking and drinking. Using tobacco products harms your body in many ways, including robbing it of estrogen, which puts you at risk for accelerated bone loss. Heavy alcohol consumption also leads to bone loss. If you’re having trouble controlling your smoking or drinking, ask your doctor for a referral to a specialist or a quitting program.
• Consider preventative medications. If you're at high risk for osteoporosis, ask your doctor about the possibility of taking prescription medications called bisphosphonates, such as alendronate and ibandronate. Estrogen therapy may also prevent bone loss. Shmerling says that these medications generally do not interfere with RA drug therapies.

“Should I Get Tested for Bone Loss?”

A simple, short, and painless bone density test can check for osteoporosis. Generally recommended for women 65 and up and for men 70 and up, younger people who have additional risk factors for osteoporosis also may benefit from a bone density test. Other than rheumatoid arthritis, risk factors include having a thin frame, being of Caucasian descent, and having a family history of osteoporosis. If you're concerned about developing osteoporosis, ask your doctor about having this test as part of your RA management plan.