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World J Rheumatol. Mar 12, 2015; 5(1): 23-35
Published online Mar 12, 2015. doi: 10.5499/wjr.v5.i1.23
Osteoporosis in rheumatic diseases
Li-Xia Gao, Hong-Tao Jin, Xiao-Mei Xue, Jia Wang, Dong-Gang Liu
Li-Xia Gao, Hong-Tao Jin, Department of Rheumatology, the Second Hospital of Heibei Medical University, Shijiazhuang 050011, Hebei Province, China
Xiao-Mei Xue, Jia Wang, Dong-Gang Liu, Biomedical Engineering Center of Hebei Medical University, Shijiazhuang 050011, Hebei Province, China
Author contributions: Gao LX wrote the paper and searched the literature; Jin HT performed literature retrieval and analysis; Xue XM and Wang J revised the paper; Liu DG designed the review.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong-Gang Liu, PhD, Professor, Biomedical Engineering Center of Hebei Medical University, No. 9 Tiyu North Street, Shijiazhuang 050011, Hebei Province, China. dgliu_hb@163.com
Telephone: +86-311-85917868 Fax: +86-311-85917868
Received: June 24, 2014
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
Processing time: 267 Days and 0.7 Hours
Abstract

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.

Keywords: Rheumatic diseases; Osteoporosis; Systemic lupus erythematosus; Rheumatoid arthritis; Spondyloarthritis; Chronic inflammation

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.