| [ Summary ] |
Patients with rheumatoid arthritis (RA) develop both periarticular and generalized osteoporosis. Periarticular osteopenia in appendicular bones occurs early in the course of RA and is one of the earliest radiological signs of RA. Generalized osteoporosis is also common in RA and leads to an increased risk of fractures. Generalized osteoporosis is considered to be multi factorial. Corticosteroids and a menopausal state are important risk factors for lumbar osteoporosis. The diagnostic criteria for primary osteoporosis are also valid for the diagnosis of generalized osteoporosis in RA. In patients treated with daily doses of 7.5mg or more of predonisolone, however, we must start treatments to prevent bone loss, if the patients are diagnosed as osteopenia, using the diagnostic criteria for primary osteoporosis.
Glucocorticoids remain a key component in the management of many inflammatory disorders but the adverse consequences, especially on bone, can be devastating. The incidence of glucocorticoid-induced osteoporosis (GIO) may be as high as 50% after 6 months' treatment with steroids. This manifests itself as a 30 to 400% increase in the incidence of low trauma fractures. The concomitant prescription of bone-active drugs for the prevention and treatment of GIO remains low, despite the availability of effective therapies. In addition, there remain many unanswered questions about the pathogenesis of GIO and its clinical management. These include identification of the optimum bone mineral density threshold at which to intervene with bone-active drugs, the dose or duration of exposure to steroid therapy warranting intervention. |