Osteoporosis In Rheumatic Diseases Research Articles

Osteoporosis in Rheumatic Diseases

The risk of osteoporosis and fragility fracture is increased in patients with autoimmune rheumatic diseases. Although the use of glucocorticoids is the major contributing factor, inflammation mediated by cytokines and growth factors and other medications, including the biologic and targeted disease-modifying antirheumatic drugs, also play important roles in bone remodeling. Pro-inflammatory cytokines such as IL-1, IL-6, IL-17, and TNF[Formula: see text] increase RANK expression and promote osteoclast activity while inhibiting osteoblast-mediated bone formation through the Dickkopf-1 pathway. Certain autoantibodies stimulate differentiation of the osteoclasts, resulting in localized bone resorption. This article covers the prevalence and risk factors for osteoporosis in patients with common rheumatic diseases and the role of inflammatory cytokines and other clinical factors. Controlling disease-related inflammation and optimizing the diagnostic and therapeutic instrumentation is needed to reduce fragility fractures in patients with rheumatic diseases.

Osteoporosis in rheumatic diseases

The article presents a review of studies that have examined osteoporosis in rheumatic diseases, including rheumatoid arthritis, spondylarthritis, psoriatic arthritis, systemic connective tissue diseases, and systemic vasculitis. The review discusses the pathogenesis, diagnosis and treatment of osteoporosis in these diseases, presents the results of epidemiological studies assessing the risk factors and the prevalence of osteoporosis in rheumatic diseases. There was a high prevalence of osteoporosis and fractures in rheumatic diseases, exceeding the population, associated primarily with systemic and local inflammation, as well as with the intake of glucocorticoids. It is indicated that the existing strategies for the treatment of rheumatic diseases may partially reduce bone loss, but long-term administration of glucocorticoids, on the contrary, increase bone resorption. The review presents data on the medications for the treatment of osteoporosis and approaches to the treatment of glucocorticoid osteoporosis.

Osteoporosis in Rheumatic Diseases.

Osteoporosis is a chronic disease characterized by an increased risk of fragility fracture. Patients affected by rheumatic diseases are at greater risk of developing osteoporosis. The purpose of the present review is to discuss the pathogenesis, epidemiology, and treatment of osteoporosis in patients affected by rheumatic diseases with special focus for rheumatoid arthritis, psoriatic arthritis, spondyloarthritis, systemic lupus erythematosus, systemic sclerosis, vasculitides, Sjogren syndrome, and crystal-induced arthritis.

Osteoporosis in Rheumatic Diseases: Anti-rheumatic Drugs and the Skeleton.

Osteoporosis in rheumatic diseases is a very well-known complication. Systemic inflammation results in both generalized and localized bone loss and erosions. Recently, increased knowledge of inflammatory process in rheumatic diseases has resulted in the development of potent inhibitors of the cytokines, the biologic DMARDs. These treatments reduce systemic inflammation and have some effect on the generalized and localized bone loss. Progression of bone erosion was slowed by TNF, IL-6 and IL-1 inhibitors, a JAK inhibitor, a CTLA4 agonist, and rituximab. Effects on bone mineral density varied between the biological DMARDs. Medications that are approved for the treatment of osteoporosis have been evaluated to prevent bone loss in rheumatic disease patients, including denosumab, cathepsin K, bisphosphonates, anti-sclerostin antibodies and parathyroid hormone (hPTH 1-34), and have some efficacy in both the prevention of systemic bone loss and reducing localized bone erosions. This article reviews the effects of biologic DMARDs on bone mass and erosions in patients with rheumatic diseases and trials of anti-osteoporotic medications in animal models and patients with rheumatic diseases.

The Role of Monocyte Percentage in Osteoporosis in Male Rheumatic Diseases.

Osteoporosis is easily overlooked in male patients, especially in the field of rheumatic diseases mostly prevalent with female patients, and its link to pathogenesis is still lacking. Attenuated monocyte apoptosis from a transcriptome-wide expression study illustrates the role of monocytes in osteoporosis. This study tested the hypothesis that the monocyte percentage among leukocytes could be a biomarker of osteoporosis in rheumatic diseases. Eighty-seven males with rheumatic diseases were evaluated in rheumatology outpatient clinics for bone mineral density (BMD) and surrogate markers, such as routine peripheral blood parameters and autoantibodies. From the total number of 87 patients included in this study, only 15 met the criteria for diagnosis of osteoporosis. Both age and monocyte percentage remained independently associated with the presence of osteoporosis. Steroid dose (equivalent prednisolone dose) was negatively associated with BMD of the hip area and platelet counts were negatively associated with BMD and T score of the spine area. Besides age, monocyte percentage meets the major requirements for osteoporosis in male rheumatic diseases. A higher monocyte percentage in male rheumatic disease patients, aged over 50 years in this study, and BMD study should be considered in order to reduce the risk of osteoporosis-related fractures.

Imaging in osteoporosis in rheumatic diseases.

Osteoporosis is a common comorbidity of all major rheumatic diseases, and manifests itself both systemically and locally. Systemic bone loss manifests because of several factors, primarily inflammation, immobility, and commonly used medical treatment for rheumatic diseases. Local bone loss manifests as periarticular demineralization and bone erosion due to local release of inflammatory agents and cytokines, which promote bone resorption. All these factors contribute to the phenomenon of arthritis-associated osteoporosis. This review summarized the currently available and used methods that play a role in the diagnosis and monitoring of osteoporosis and in the detection of osteoporotic fractures.

Osteoporosis in rheumatic diseases

Osteoporosis in rheumatic diseases

Epidemiologia dell’osteoporosi nelle malattie reumatologiche

To date, many studies have tried to establish the impact of osteoporosis and related fragility fractures in rheumatic diseases. Several cross-sectional studies reported that disability and reduced motility 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 inflammation remains probably the main concern when considering treatment options. Besides these variables, pharmacologic agents commonly used in the treatment of rheumatic diseases have probably an adjunctive effect on bone loss in rheumatic patients. Large epidemiological studies have clearly demonstrated that patients with rheumatoid arthritis, systemic lupus erythematosus and ankylosing spondylitis are at increased risk for fragility fractures. Further studies are required to investigate the impact of osteoporosis and fragility fractures in other rheumatic diseases. A better appreciation of the impact and mechanisms of osteoporosis in rheumatic diseases by rheumatologists represents a clinical challenge but certainly a greater understanding of this frequent complication will improve the quality of health care and the lives of rheumatic patients.

Osteoporosis in rheumatic diseases

Osteoporosis in rheumatic diseases

Osteoporosis and the Osteoporosis of Rheumatic Diseases: A Companion to Rheumatology, 1st edition

Osteoporosis and the Osteoporosis of Rheumatic Diseases: A Companion to Rheumatology, 1st edition

IV: Small group workshop for developing future measures and projects. Evidence-based therapy in rheumatology with special reference to applications of new drugs--formulation of possible goals and possibilities for meeting them. Osteoporosis in rheumatic diseases

Secondary osteoporosis is a common, late complication of inflammatory rheumatic diseases. Despite its great socio-economic implications for the individual, there is still a lack of appreciation of this problem. This may result in an inadequate or insufficient prophylaxis and therapy. The participants of this discussion group, therefore, approve of further investigations in this field to gather new relevant data, e.g., for our core documentation on rheumatic diseases. Of special importance is the registration of long-term patients obtaining documented, individual long-term therapy (e.g., cortisone). As well as epidemiologic and clinical research projects, it is imperative to do basic research into the pathogenesis of secondary osteoporosis and find new therapeutic approaches for curing rheumatic disease.

Session 5: Osteoporosis

Severe autoimmune rheumatic diseases, such as SLE and RA, occur more frequently in females, who are more prone than males to develop osteoporosis. Local and systemic inflammation are characteristic features of these diseases. Cytokines and prostaglandins, which are released and play key roles in the inflammatory and autoimmune processes involved. may also affect bone metabolism and contribute to osteoporosis.Often rheumatic diseases affect and damage joints causing limitation of motion, thus creating the conditions for further development of osteoporosis.Some inflammatory rheumatic diseases are managed with corticosteroids, methotrexate and other immunosuppressive medications. These therapeutic interventions, especially high dose and long term corticosteroids. are among the major risk factors for the development of osteoporosis in patients with rheumatic diseases.In addition, certain patients with severe inflammatory incurable rheumatic disease may have been told to try a milk and dairy food free diet in hopes of combating their disease. However, the resulting reduced intake of calcium may contribute to the development of osteoporosis. Others, with autoimmune conditions, may avoid estrogen replacement therapy.In our times, when new modalities are available for preventing or decreasing the severity of osteoporosis. it is important to increase alertness to risk factors for the development of osteoporosis in rheumatic diseases, which unfortunately are both numerous and real.