What women with arthritis need to know about osteoporosis

Human knee, illustration

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When you think about the parts of the body affected by rheumatoid arthritis (RA), your mind probably goes to the joints. After all, inflammatory autoimmune disease primarily affects areas such as the fingers, wrists, and knees. But there is also another part of the body that could be damaged: your bones. This is because having RA can dramatically increase the risk of bone loss and fractures. A review of 13 studies found those with RA are nearly twice as likely to have it osteoporosis (a condition in which bone tissue deteriorates) compared to people who don’t have it.

Here’s what’s going on and what you can do to keep yourself safe and sound.

The link between arthritis and osteoporosis

Although the RA-osteoporosis connection may seem coincidental, it comes as no surprise to rheumatologists. This is because both the underlying inflammation associated with RA and many of the treatments prescribed for it can inadvertently lead to bone loss.

“Inflammation can predispose bones to thinning,” says Anca Askanase, MD, a rheumatologist at New York-Presbyterian and Columbia University Medical Center. “Also, some of the drugs people take for RA increase their risk.”


When viewed under a microscope, healthy bone looks like a honeycomb. With osteoporosis, bone loss occurs, which causes the spaces in the honeycomb to expand, leaving the bone more susceptible to breaking and fracturing.

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For example, steroids and other traditional RA medications can thin bones, while proton pump inhibitors, which some people with RA take to protect their stomach, can reduce calcium absorption, according to Dr. Askanase. (Football is stored in the bones and it’s crucial to keep them strong.)

And then there is the fact that many people with RA are not as active as they once were. “When you feel a lot of pain and inflammation and don’t move as well, you stop being physically active, which can increase your risk of bone loss,” says Dr. Askanase. This is because exercise doesn’t just build strong muscles, but also strengthen your skeleton. Bones are made up of living tissue, and when you force them on, say, jogging or playing tennis, they react by becoming denser.

Keep your bones strong

So what should you do to protect your bones if you have RA? “Some of the bone-weakening drugs are needed as part of treatment, so you can’t just avoid them,” says Dr. Askinase. “Awareness of the problem is important, though.”

She suggests asking your doctor to check your bone density regularly, and if there is any concern about your thinning bones, make sure you are getting enough calcium and vitamin D, which helps your body absorb calcium. Look for calcium in foods such as milk, yogurt and cheese and you get vitamin D from fortified milk and egg yolks (and sunlight!). You can also easily find both in supplement form.

Living with RA and osteoporosis

“If you find that you already have osteoporosis, talk to your doctor about treatments or lifestyle changes,” says Dr. Askinase.

For example, doing more exercises with weights like walking and dancing can help. Of course, don’t push yourself beyond what your body can do, but if you’re able to be active, work on it throughout your day. Everyone’s rheumatoid arthritis symptoms are slightly different, so ask your doctor for advice on how much movement and which type you should strive for each day.

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