Osteoporosis prevalence remains high in patients with rheumatoid arthritis
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Osteoporosis remains highly prevalent among patients with rheumatoid arthritis despite advancements in prevention and treatment, according to data published in Scientific Reports.
“Osteoporosis (OP) is one of the most known common extra-articular complications of RA and its prevalence in RA patients is almost twice that of the general population,” Samaneh Moshayedi, a member of the student research committee at Arak University of Medical Sciences, in Iran, and colleagues wrote. “Despite advances in the identification of the destructive mechanism and pharmacological treatment of RA, the complications associated with this disease are still common.”
To examine the prevalence of osteoporosis in patients with RA, Moshayedi and colleagues conducted a systematic review and meta-analysis of three international databases — Medline, Scopus and Web of Science — using specific keywords. Articles with full text available in English were indexed, spanning from 1962 through June 22, 2021. They included all observational studies in which osteoporosis was reported in patients with RA.
All potentially related articles were entered into a software that selected duplicates, which were then removed. Remaining titles and abstracts were manually screened, and irrelevant articles were similarly excluded. Finally, a full text screen was performed to evaluate whether remaining articles met the inclusion criteria. All clinical trials, letters to the editor, editorials, review articles, commentaries, case reports, case series and papers with no relevant data were excluded. Required data were extracted and entered into Excel software for analysis.
The review included a total of 57 studies, representing 227,812 cases of RA and 64,290 cases of osteoporosis. The summary-point prevalence was estimated at 27.6% (95% CI, 23.9% to 31.3%), according to the researchers. The highest prevalence was found in the period from 2011 to 2015, at 36.2% (95% CI, 24.5% to 47.8), while the region with the highest prevalence was Africa, with 46.1% (95%CI, 40.8% to 51.3%).
“Despite significant advances in prevention, treatment and diagnostic methods in RA patients, it still seems that the prevalence of OP in these patients is high and requires better and timelier interventions,” Moshayedi and colleagues wrote. “The results suggest that the prevalence of RA has been declining in recent years, which may be attributed to the increase of human knowledge about drugs that suppress RA and timely imaging studies for early diagnosis and adequate treatment.”
References:
- Herrera A, et al. Maturitas. 2015;doi:10.1016/j.maturitas.2014.12.004.
- Hu Z, et al. BMC Musculoskelet. 2021;doi:10.1186/s12891-021-04403-5.
- Mazzucchelli R, et al. RMD Open. 2018;doi:10.1136/rmdopen-2018-000671.
- Phuan-Udom R, et al. Clin Rheumatol. 2018;doi: 10.1007/s10067-018-4218-8.
Perspective
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The review conducted by Moshayedi and colleagues estimated the prevalence of osteoporosis in patients with rheumatoid arthritis to be nearly 30%. This result highlights the importance of not only screening our RA patients for osteoporosis, but educating them on risk factors and lifestyle modifications that can help them to reduce the risk for osteoporosis.
I think we need to do a better job of educating all our patients on the preventability of osteoporosis by encouraging them to get proper calcium and Vitamin D intake, not only through supplementation, but through diet; demonstrating proper and appropriate weight bearing and resistance exercises; and creating healthy lifestyle habits, such as smoking cessation and limiting alcohol intake. Through proper education, providers can empower patients to take an active role in preventing osteoporosis, which will hopefully lead to a decrease in prevalence among our patients with RA.
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