Understand and Manage Inflammatory Arthritis and Bone Loss

Inflammatory arthritis. Chronic inflammation contributes to bone damage, possibly by stimulating osteoclasts, bone cells that deplete bone minerals, says Seoyoung C. Kim, MD, a rheumatologist at Brigham and Women’s Hospital in Boston. 

Medications. Certain medications used to treat inflammatory arthritis can speed up bone density loss. Prednisone, a corticosteroid drug used for decades to control inflammation, is a notorious culprit in bone density loss. 

“Prednisone stops the function of bone-forming cells. When that happens, the body still needs calcium, so it takes it out of the bone, but it’s not allowing the bone-forming cells to put it back,” says Dr. Kim. 
High doses of methotrexate, another medication often used by people with inflammatory arthritis, have been linked to bone loss. Low-dose methotrexate is now the treatment norm, however, and recent studies show low doses don’t increase the risk for osteoporosis in people with inflammatory arthritis. 

Proton pump inhibitors (PPI), which are used by some people with inflammatory arthritis to protect the stomach from the effects of nonsteroidal anti-inflammatory drugs (NSAIDs), can interfere with the absorption of bone-building calcium. Take a PPI on an empty stomach before breakfast followed by a calcium supplement with food to promote better absorption, says Dr. Kim.

Other risk factors for bone loss include: 

• Aging and menopause.
• Lack of weight-bearing exercise. 
• Too little dietary calcium. 
• Cigarette smoking and excessive alcohol use.

Prevent bone loss: “People with inflammatory arthritis should “modify any risk factors [for bone loss] they can, because prevention is key,” says Carolyn Felton, MD, a rheumatologist at Piedmont Arthritis and Rheumatology in Atlanta. “If you have inflammatory arthritis, you could also start preventive measures at a younger age.” 

Treat inflammation aggressively and early: This may prevent damage to bones, cartilage, and other tissue, Dr. Felton says. Medications effective at treating underlying inflammation help prevent bone loss and loss of function. Some studies suggest the biologic class of drugs, which include the TNF inhibitors etanercept and adalimumab, may help reduce bone loss or boost bone regrowth in people with inflammatory arthritis.
 
Do regular weight-bearing exercise: Low-impact weight-bearing exercises recommended by the National Osteoporosis Foundation for bone loss prevention include walking, working out on an elliptical or stair-step machine, and low-impact aerobics classes. 

Eat a healthy diet rich in calcium: Good food sources are dairy products, dark leafy greens, beans and lentils, and sardines. Also look for calcium-fortified foods and beverages. If it’s hard to get enough calcium through diet alone, ask your doctor about calcium supplements. 
 
Ask your doctor to check your vitamin C levels and recommend a supplement if you’re deficient. Most Americans don’t get enough of this vitamin that’s important to bone health. 

Quit smoking and keep alcohol consumption moderate:  Studies show a direct link between tobacco use and decreased bone density.  Also,  chronic heavy drinking, especially when it starts in teenage and young adult years, can affect bone quality and may increase osteoporosis risk.