How do rheumatoid arthritis and other inflammatory diseases affect bone density?
Systemic inflammatory and autoimmune diseases, including rheumatoid arthritis, systemic lupus erythematosus, scleroderma, mixed connective tissue disease, ulcerative colitis and Crohn’s disease, have all been associated with decreased bone mineral density and increased fracture risk via multifactorial mechanisms (1-4). While corticosteroid use in all these diseases has been shown to decrease BMD, many pro-inflammatory cytokines have been shown to promote bone resorption. Hypogonadism and immobilization also contribute to decreased BMD in these diseases. Malabsorption, especially of vitamin D, affects BMD in inflammatory bowel disease. Rheumatoid arthritis affects bone density through generalized osteopenia, as seen in other inflammatory diseases, periarticular osteopenia and focal subchondral erosions. The synovial tissue proliferation in rheumatoid arthritis promotes the development of osteoclast-like cells from mononuclear cell precursors, which then cause focal osteolysis at the art
