Osteoporosis in some inflammatory rheumatic diseases

Overview

Chronic inflammatory rheumatic diseases are associated with higher risk of low bone mass density. Prevalence of osteoporosis/osteopenia in these patients is significantly increased compared to healthy individuals and the reasons for this fact are complex. Pro-inflammatory cytokines, such as IL-6 or TNF-α, that are produced in chronic inflammatory diseases, play a key role in the stimulation of bone resorption. They induce osteoclastogenesis by means of RANKL/RANK/OPG system and activate mature osteoclasts. The best model of osteoporosis described in the literature represents rheumatoid arthritis. Bone turnover in inflammatory rheumatic diseases is also affected by low physical activity of the patients and further factors that are specific for particular diseases (e.g. alteration of vitamin D metabolism in patients with systemic lupus erythematosus). Immunosuppressive treatment, particularly high doses of glucocorticoids, contributes significantly to the bone loss. Chronic inflammatory rheumatic diseases are associated with higher rate of fracture, particularly vertebral deformities.

Key words:
osteoporosis, rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, dermatomyositis/polymyositis, glucocorticoids