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Bone Abstracts (2013) 1 CU2.2 | DOI: 10.1530/boneabs.1.CU2.2

ECTS2013 Clinical Update Clinical Update 2 (6 abstracts)

Osteoporosis and fragility fractures in rheumatoid arthritis

Glenn Haugeberg 1,


1Hospital of Southern Norway Trust, Kristiansand, Norway; 2NTNU University, Trondheim, Norway.


In rheumatoid arthritis (RA) bone is affected by erosions, periarticular- and generalised osteoporosis, the latter leading to increased risk of both vertebral and non-vertebral fractures. A twofold increase in osteoporosis has been found in the RA population compared with healthy controls. In the RA population the relative risk of hip fracture has been reported to be up to five times higher and vertebral fractures up to three times higher than controls. Osteoporotic fractures are not only associated with increased morbidity and impaired quality of life but also with increased mortality.

Generalised osteoporosis in RA is frequently associated with simultaneous presence of primary osteoporosis risk factors and the disease related risk factors: inflammation, immobilisation, and treatment with corticosteroids (CS). In the WHO fracture risk assessment tool (FRAX) RA is also recognised as an independent risk factor for future fractures.

Previously, the three bone manifestations were thought to be caused by different mechanisms. However, recent studies suggest that both bone erosion and osteoporosis (peri-articular as well as generalised osteoporosis) are mediated by the cellular action of osteoclasts. Tumor necrosis factor α (TNFα), interleukin 1 (IL1) and IL6, which play a pivotal role in the pathogenesis of synovitis in RA, are also found to be regulators of osteoclastic bone resorption, mediated through interactions with the receptor activator of NF-κβ ligand (RANKL)). This common cellular osteclast pathway, being a direct consequence of the inflammatory disease process, invites opportunities for both new treatment strategies and new ways of assessing patients with RA which includes both aggressive anti-inflammatory treatment and the use of potent osteoclast inhibitors, e.g. denosumab and bisphosphonates.

Doctors should be aware of this increased risk of osteoporosis and fragility fracture in RA patients and strengthen their effort in reducing fracture risk.

Volume 1

European Calcified Tissue Society Congress 2013

Lisbon, Portugal
18 May 2013 - 22 May 2013

European Calcified Tissue Society 

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