Epidemiology of Osteoporosis in Rheumatic Diseases

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Epidemiology of osteoporosis in rheumatoid arthritis

Involvement of bone in RA was described first by Barwell in 1865 [2]. Since then it has been well known that generalized and iuxta-articular osteoporosis can occur in RA. The magnitude of generalized osteoporosis in RA is difficult to assess, and available data come from cross-sectional studies that aimed to evaluate the prevalence of this complication. When comparing different studies it is important to recognize potential problems in data interpretation that are related to inclusion criteria

Epidemiology of osteoporosis in systemic lupus erythematosus

The outstanding improvement in the survival rates of patients who have SLE that has been achieved over the last few decades has directed attention to the morbidity that is associated with the disease and its treatment in long-term survivors. Many researchers have focused their attention on bone loss in these patients, and an increasing number of studies has been published recently on osteoporosis in patients who have SLE.

Pathogenetically, SLE could result in bone loss through several mechanisms

Epidemiology of osteoporosis and fractures in ankylosing spondylitis

AS is the prototypical disease of a heterogeneous group of rheumatic disorders, which is called spondyloarthropathies (SspAs), that shares chronic inflammation of the axial skeleton as a common feature. Despite extraosseous new bone formation being considered a hallmark of AS, osteoporosis is a well-recognized feature that occurs even in the early, mild form of AS and leads to an increased rate of fractures. Radiographic bone loss has long been recognized in predensitometric studies [75], [76],

Systemic sclerosis

Systemic sclerosis (SSc) is a connective tissue disorder that is characterized by fibrosis, degenerative changes, and vascular lesions of the skin with internal organ involvement. Several studies reported that SSc is associated with osteoporosis by different possible pathogenetic mechanisms. Besides a chronic inflammation state, a reduced bone mass in patients who have SSc could be related to a decreased physical activity, low body mass index, earlier menopause, decreased vitamin D synthesis in

Psoriatic arthritis

Differently from RA, studies about skeletal involvement in patients who have psoriatic arthritis (PsA) are scanty, probably because osteoporosis is a less frequently recognized feature in these subjects. Patients with axial involvement have been included in studies of patients who have AS [78], [93], [94], without reported differences in comparison with other axial SspAs. With regard to oligo/polyarthritic subsets, PsA is believed to be associated with less severe periarticular bone loss than

Polymyalgia rheumatica

Polymyalgia rheumatica (PMR) is an inflammatory disease that affects the elderly population and is treated commonly with corticosteroids. Some studies on patients who have PMR were designed to address the effects on bone metabolism that are exerted by low-dose corticosteroids. But the disease itself seems to alter bone turnover, which causes bone loss early in the disease, before treatment. Dolan and colleagues [113] showed increased levels of resorption markers that correlated with

Epidemiology of osteoporosis in osteoarthritis

Osteoporosis and OA are the two most common musculoskeletal age-related disorders that may coexist in the same elderly population; however, the potential relationship between these two diseases is controversial and is not understood completely. An inverse association between osteoporosis and OA has been described extensively in the past.

More than 30 years ago some orthopedic surgeons reported on the absence of osteoarthritic changes in excised femoral heads from subjects with hip fractures [115]

Summary

Much work has been directed at establishing the impact of osteoporosis and related fragility fractures in rheumatic diseases. Several cross-sectional studies reported that disability and reduced motility that are due to functional impairment are among the most important determinants of bone loss in different rheumatic diseases. At the same time, longitudinal studies have confirmed the detrimental effect of uncontrolled disease activity on bone density. In this perspective, the suppression of

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References (144)

  • G. Haugeberg et al.

    Reduced bone mineral density in male rheumatoid arthritis patients

    Arhritis Rheum

    (2000)
  • P.N. Sambrook et al.

    Determinants of axial bone loss in rheumatoid rrthritis

    Arthritis Rheum

    (1987)
  • O.R. Madsen et al.

    Bone quality and bone mass as assessed by quantitative ultrasound and dual energy X-ray absorptiometry in women with rheumatoid arthritis: relationship with quadriceps strength

    Ann Rheum Dis

    (2002)
  • A. Hakkinen et al.

    A randomized two year study of the effects of dynamic strength training on muscle strength, disease activity, functional capacity and bone mineral density in early rheumatoid arthritis

    Arthritis Rheum

    (2001)
  • M. Hansen et al.

    Bone loss in rheumatoid arthritis. Influence of disease activity, duration of the disease, functional capacity and corticoid treatment

    Scand J Rheumatol

    (1996)
  • O.S. Als et al.

    Are disease duration and degree of functional impairment determinants of bone loss in rheumatoid arthritis?

    Ann Rheum Dis

    (1985)
  • D. Shawe et al.

    Physical activity as a determinant of bone conservation in the radial diaphysis in rheumatoid arthritis

    Ann Rheum Dis

    (1993)
  • P.N. Sambrook et al.

    Osteoporosis in rheumatoid arthritis: safety of low-dose corticosteroids

    Ann Rheum Dis

    (1986)
  • M.S. Leboff et al.

    Low-dose prednisone does not affect calcium homeostasis or bone density in postmenopausal women with rheumatoid arthritis

    J Rheumatol

    (1991)
  • R.F.J.M. Laan et al.

    Vertebral osteoporosis in rheumatoid arthritis patients: effect of low-dose prednisolone therapy

    Br J Rheumatol

    (1992)
  • G.M. Hall et al.

    The effect of rheumatoid arthritis and steroid therapy on bone density in postmenopausal women

    Arthritis Rheum

    (1993)
  • K. Shibuya et al.

    Cross-sectional and longitudinal study of osteoporosis in patients with rheumatoid arthritis

    Clin Rheumatol

    (2002)
  • P. Sambrook et al.

    Osteoporosis with low-dose corticosteroids: contribution of underlying disease effects and discriminatory ability of ultrasound versus bone densitometry

    J Rheumatol

    (2001)
  • N.E. Lane et al.

    Rheumatoid arthritis and bone mineral density in elderly women

    J Bone Min Res

    (1995)
  • T.P. Van Staa et al.

    The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis

    Oteoporos Int

    (2002)
  • F.N. Ton et al.

    Effects of low-dose prednisone on bone metabolism

    J Bone Min Res

    (2005)
  • O. Di Munno et al.

    Effect of low-dose methotrexate on bone density in women with rheumatoid arthritis: results from a multicenter cross-sectional study

    J Rheumatol

    (2004)
  • G. Haugeberg et al.

    Bone loss in patients with rheumatoid arthritis

    Arthritis Rheum

    (2002)
  • B.D. Shenstone et al.

    Longitudinal bone mineral density changes in early rheumatoid arthritis

    Br J Rheumatol

    (1994)
  • A.A. Kalla et al.

    Increased metacarpal bone mass following 18 months of slow-acting antirheumatic drugs for rheumatoid arthritis

    Br J Rheumatol

    (1991)
  • A.L. Dolan et al.

    Does active treatment of rheumatoid arthritis limit disease-associated bone loss?

    Rheumatol

    (2002)
  • M. Quinn

    The effect of TNF blockade on bone loss in early rheumatoid arthritis

    Arthritis Rheum

    (2002)
  • P.N. Sambrook

    The skeleton in rheumatoid arthritis: common mechanisms for bone erosion and osteoporosis?

    J Rheumatol

    (2000)
  • M.C. Lodder et al.

    Bone mineral density in patients with rheumatoid arthritis: relation between disease severity and low bone mineral density

    Ann Rheum Dis

    (2004)
  • H. Forsblad d'Elia et al.

    Radiographic joint destruction in postmenopausal rheumatoid arthritis is strongly associated with generalised osteoporosis

    Ann Rheum Dis

    (2003)
  • K. Forslind et al.

    Reduced bone mineral density in early rheumatoid arthritis is associated with radiological joint damage at baseline and after two years in women

    J Rheumatol

    (2003)
  • A. Gough et al.

    Osteoclastic activation is the principal mechanism leading to secondary osteoporosis in rheumatoid arthritis

    J Rheumatol

    (1998)
  • P. Garnero et al.

    Association of baseline levels of markers of bone and cartilage degradation with long-term progression of joint damage in patients with early rheumatoid arthritis

    Arthritis Rheum

    (2002)
  • M.C. Lodder et al.

    Radiographic damage associated with low bone mineral density and vertebral deformities in rheumatoid arthritis: the Oslo-Truro-Amsterdam (OSTRA) Collaborative Study

    Arthritis Rheum

    (2003)
  • J.R. Hooyman et al.

    Fractures after rheumatoid arthritis: a population-based study

    Arthritis Rheum

    (1984)
  • N.F.A. Peel et al.

    Risk of vertebral fracture and relationship to bone mineral density in steroid treated Rheumatoid Arthritis

    Ann Rheum Dis

    (1995)
  • R.E. Orstavik et al.

    Vertebral deformities in rheumatoid arthritis

    Arch Intern Med

    (2004)
  • C. Cooper et al.

    Rheumatoid arthritis, corticosteroid therapy and hip fracture

    Ann Rheum Dis

    (1995)
  • T.M. Huusko et al.

    Threefold increased risk of hip fractures with rheumatoid arthritis in central Finland

    Ann Rheum Dis

    (2001)
  • R.E. Orstavik et al.

    Self reported non-vertebral fractures in rheumatoid arthritis and population based controls: incidence and relationship with bone mineral density and clinical variables

    Ann Rheum Dis

    (2004)
  • B.A. Michel et al.

    Fractures in rheumatoid arthritis: an evaluation of associated risk factor

    J Rheumatol

    (1993)
  • R.E. Orstavik et al.

    Vertebral deformities in 229 female patients with Rheumatoid Arthritis: associations with clinical variables and bone mineral density

    Arthritis Rheum

    (2003)
  • H. Kaz Kaz et al.

    Fall-related risk factors and osteoporosis in women with rheumatoid arthritis

    Rheumatol

    (2004)
  • M. Jamison et al.

    Correlates of falls and fear of falling among adults with rheumatoid arthritis

    Arthritis Rheum

    (2003)
  • G. Haugeberg et al.

    Clinical decision rules in rheumatoid arthritis: do they identify patients at high risk for osteoporosis? Testing clinical criteria in a population based cohort of patients with rheumatoid arthritis recruited from the Oslo Rheumatoid Arthritis Register

    Ann Rheum Dis

    (2002)
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