Epidemiology of Osteoporosis in Rheumatic Diseases
Section snippets
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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