What women with arthritis need to know about osteoporosis

When you think of the body parts that rheumatoid arthritis (RA) impacts, your mind probably goes to your joints. After all, the inflammatory autoimmune disease mainly affects areas like your fingers, wrists, and knees.

But there is another body part that might be harmed as well: your bones. That’s because having RA can drastically raise your risk for bone loss and fractures. One review of 13 studies found those with RA are almost twice as likely to have osteoporosis (a condition where the tissue in bones deteriorates) than people who don’t have it.

Here’s what’s going on and what you can do to keep yourself safe and healthy.

The link between arthritis and osteoporosis

While the RA-osteoporosis connection might seem random, it doesn’t come as a surprise to rheumatologists. That’s because both the underlying inflammation associated with RA and many of the treatments prescribed for it can inadvertently lead to bone loss.

“The inflammation can predispose your bones to thinning,” says Anca Askanase, MD, a rheumatologist at New York-Presbyterian and Columbia University Medical Center. “On top of that, some of the medications people take for RA take also increase the risk.”

Viewed under a microscope, healthy bone looks like a honeycomb. With osteoporosis comes bone loss, which causes the spaces in the honeycomb to expand, leaving the bone more susceptible to breaks and fractures.

For example, steroids and other traditional RA drugs can thin your bones, while proton pump inhibitors, which some people with RA take to protect their stomachs, can decrease the absorption of calcium, according to Dr. Askanase. (Calcium is stored in bones and is crucial to keeping them strong.)

And then there is the fact that many people with RA just aren’t as active as they used to be. “When you feel a lot of pain and inflammation and don’t move as well, you stop being physically active, which can increase your risk for bone loss,” says Dr. Askanase. That’s because exercise doesn’t just build strong muscles—it also strengthens your skeleton. Bones are made up of living tissue, and when you put force on them by, say, jogging or playing tennis, they react by getting denser.

Keeping your bones strong

So, what are you supposed to do to protect your bones if you have RA? “Some of the bone-weakening medications are needed as part of your treatment, so you can’t just avoid them,” says Dr. Askinase. “Awareness of the problem is important, though.”

She suggests asking your doctor to routinely check your bone density and, if there’s any concern about your bones getting thinner, making sure you’re getting enough calcium and vitamin D, which helps your body absorb calcium. Look for calcium in foods like milk, yogurt, and cheese and get vitamin D from fortified milk and egg yolks (and from sunlight). You can also easily find both in supplement form.

Living with RA and osteoporosis

“If you find out that you already have osteoporosis, talk to your doctor about treatments or lifestyle changes,” Dr. Askinase says.

For example, doing more weight-bearing exercise like walking and dancing can help. Obviously, don’t push yourself beyond what your body can do, but if you’re able to be active, work it into your day. Everyone’s rheumatoid arthritis symptoms are slightly different, so ask your doctor for recommendations on how much movement—and what type—you should strive for every day.