Published online Mar 12, 2015. doi: 10.5499/wjr.v5.i1.23
Peer-review started: June 25, 2014
First decision: August 28, 2014
Revised: September 19, 2014
Accepted: October 28, 2014
Article in press: October 29, 2014
Published online: March 12, 2015
Rheumatic diseases, characterized by chronic inflammation and damage to various organs and systems, include systemic lupus erythematosus, rheumatoid arthritis, ankylosing spondylitis and other connective tissue diseases. Bone is a target in many inflammatory rheumatic diseases. In recent years, the survival of patients with rheumatic diseases has increased markedly and the relationship between rheumatic diseases and osteoporosis (OP) has become more prominent. OP and related fragility fractures increase the morbidity and mortality of rheumatic disease. The cause of OP in rheumatic diseases is complex. The pathogenesis of OP in rheumatic diseases is multifactorial, including disease and treatment-related factors. Osteoimmunology, a crosstalk between inflammatory and bone cells, provides some insight into the pathogenesis of bone loss in systematic inflammatory diseases. The aim of this article is to review different risk factors in rheumatic diseases. Several factors play a role, such as chronic inflammation, immunological factors, traditional factors, metabolism and drug factors. Chronic inflammation is the most important risk factor and drug treatment is complex in patients with OP and rheumatic disease. Attention should be paid to bone loss in rheumatic disease. Optimal treatment of the underlying rheumatic disease is the first step towards prevention of OP and fractures. Apart from that, a healthy lifestyle is important as well as calcium and vitamin D supplementation. Bisphosphonates or denosumab might be necessary for patients with a low T score.
Core tip: Osteoporosis (OP) and related fractures are one of important complications for patients with rheumatic diseases. The pathogenesis of OP in rheumatic diseases is multifactorial, including disease and treatment-related factors. Chronic inflammation is the most important risk factor and drug treatment is complex in patients with OP and rheumatic disease. Controlling rheumatic disease effectively is an important way to prevent OP.