Bones Don’t Sit Still

Bones are active organs that change every day throughout our lives, says DiMuzio. At his suburban Chicago center, he measures bone density in a variety of patients, including many with active RA, who are either at risk for or who have developed osteoporosis, a common disease where bone mineral density is considerably reduced from normal, healthy levels. 

Bone mineral density loss can occur over time due to various factors: chronic inflammation, long-term use of corticosteroid drugs, inadequate dietary intake of calcium, or lack of weight-bearing exercise that strengthens bones, DiMuzio explains. 

“Our bones are a reservoir for this key mineral, calcium. Calcium is coming out of our bones all the time. It comes out through our kidneys, and we leave it in the toilet. So we have to find a way to put calcium back into our bones,” he says.

In addition to the bone-leaching potential of corticosteroids or even methotrexate, which was used at higher, more toxic doses in the past to treat RA inflammation, other factors common in people with RA can contribute to bone loss. RA pain, swelling or fatigue may keep you from daily weight-bearing activities like walking that can help strengthen bone. 

Consumption of calcium in food or supplements can help replenish this lost mineral that is a building block of healthy bone. Yet drugs like proton pump inhibitors, used by some people with RA to protect the stomach from the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), can interfere with calcium absorption. 

As people age, they are also at increased risk of developing osteoporosis, as our bodies stop actively building bone mass at about age 30.

“A lot of our patients fit those risk factors, including age, medications and sedentary lifestyle,” says Carolyn Felton, MD, a rheumatologist at Piedmont Arthritis and Rheumatology in Atlanta. Dr. Felton was formerly on the staff of the United Osteoporosis Center in Gainesville, Fla. 

To prevent bone mineral density loss and increased fracture risk, people with RA should “modify any risk factors you can, because prevention is key. If you have RA, you could also start preventive measures at a younger age” than someone without RA might do, Dr. Felton suggests. 

She says she discusses calcium and vitamin D intake and regular weight-bearing exercise with all of her RA patients to prevent bone mineral density loss and tries to use prednisone for no more than three months’ duration if possible for the same reason.