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Should we look for osteoporosis in patients with rheumatoid arthritis?
  1. W F LEMS,
  2. B A C DIJKMANS
  1. Department of Rheumatology, Free University Hospital, Slotervaart Hospital, Jan van Breemen Institute, Amsterdam, the Netherlands
  1. Dr Lems, Department of Rheumatology, Free University Hospital, Room B417, PO Box 7057, 1007 MB Amsterdam, the Netherlands.

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Recently, rheumatologists have become more interested in osteoporosis.1 2 Obviously, this increased interest is a consequence of progress in diagnostic facilities3 and in therapeutic options of osteoporosis.1

Dual energy x ray absorptiometry (DXA) is now the most commonly used method for measuring bone mineral density (BMD). This technology, (DXA), is crucial for the diagnosis, as osteoporosis is currently defined as a T score of ⩽ −2.5 SD, according to the WHO criteria.4 DXA has become a less expensive diagnostic procedure than five years ago and DXA machines are now widely accessible. Moreover, successful prevention of further bone loss in patients with primary osteoporosis can be offered now with the introduction of new and more potent anti-osteoporotic drugs. In postmenopausal women, a decrease in the number of vertebral5 and hip fractures6 has been found with the use of alendronate. Studies on the effect on bone of other promising drugs, such as new bisphosphonates and tissue specific oestrogens, are underway.1

During the past decade, several authors have formulated guidelines on the prevention of bone loss in patients treated with corticosteroids.7-10 In addition, the ACR has recently developed recommendations for the prevention and treatment of osteoporosis in corticosteroid treated patients.11 In contrast, no consensus or guidelines exist for the prevention and treatment of osteoporosis in patients with rheumatoid arthritis (RA), although osteoporosis frequently occurs in patients with RA.2 Osteoporosis in RA patients is often related to the use of corticosteroids, but rheumatologists are increasingly aware that bone loss in RA patients may also occur in RA patients without (previous) use of corticosteroids.12-18

The negative effects of RA on bone are illustrated by three types of study, focusing on: (a) markers of bone metabolism; (b) bone mineral density; (c) fracture incidence.

Markers of bone metabolism

There is …

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