Osteoporosis in rheumatic diseases

Osteoporosis has been recognized as a serious issue in rheumatology. While osteoporosis in its local periarticular form was detected long before, recent studies demonstrate a six-fold elevated risk for fractures in patients with inflammatory joint disease. New non-invasive diagnostic tools offer rational and disease adapted therapy. Compounds with minor side effects such as calcium and vitamin D may be used early in disease. Drugs containing hormones, fluorides or bisphosphonates are restricted in their use due to adverse reactions. Therapy of osteoporosis should include control of the inflammatory disease process and its management since proinflammatory cytokines, steroids and physical disability themselves influence bone mineral denity and fracture rate.