What is arthritis?
Arthritis is a general term for conditions that affect the joints and surrounding tissues. Joints are places inthe body where bones come together, such as the knee, wrist, fingers, toes, and hips. The two most common types of arthritis are osteoarthritis and rheumatoid arthritis.
What is osteoarthritis (OA)?
Osteoarthritis is a degenerative joint disease that may affect the hips, knees, neck, lower back, or the small joints of the hands. OA usually develops in joints that are injured by repeated overuse in the performance of a job or a favorite sport, or from carrying around excess body weight. Usually, the first symptom a person with OA has is pain that worsens with lack of exercise or immobility.
What is rheumatoid arthritis (RA)?
Rheumatoid arthritis is an autoimmune inflammatory disease that may involve the hands, wrists, elbows, shoulders, knees, feet, or ankles. An autoimmune disease is one in which the body releases enzymes that attack its own healthy tissues. In RA, these enzymes destroy the linings of joints often causing pain, swelling, stiffness, deformity, and reduced movement and function. People with RA also may have systemic symptoms, such as fatigue, fever, weight loss, eye inflammation, anemia, bumps under the skin, or lung inflammation.
Does having arthritis increase the risk for bone loss?
Osteoporosis and osteoarthritis are two very different medical conditions with little in common. It is possible to be diagnosed with osteoporosis if you have either type of arthritis. However, people with rheumatoid arthritis are more likely to get osteoporosis than individuals with osteoarthritis. People with rheumatoid arthritis seem to have lower bone mass because some of the chemicals produced by the diseased joints may get into the blood and cause bone breakdown. Individuals with rheumatoid arthritis are at highest risk for osteoporosis if they need to take certain medications that can cause bone loss (such as long-term steroid medications or methotrexate) to treat their condition.
Does treatment for arthritis increase the risk for bone loss and/or osteoporosis?
The treatment for osteoarthritis will not affect your bone health in a negative way. This usually includes pain medication, topical creams, or non-steroidal anti-inflammatory medications (known as NSAIDs), appropriate exercises or physical therapy, joint splinting, or joint replacement surgery for seriously damaged larger joints such as the knee or hip. However, if you are inactive as a result of your condition, you may have bone loss.
On the other hand, the medications used to treat rheumatoid arthritis, particularly steroid medications or methotrexate, may increase your risk for bone loss, which should be discussed with your healthcare provider.
What about diseases related to rheumatoid arthritis? Do they also cause bone loss?
Some diseases related to rheumatoid arthritis, which are also considered immunologic, and fall under the heading of Connective Tissue Diseases, can also produce bone loss. These include psoriatic arthritis, lupus, scleroderma, and mixed connective tissue disease. Both the underlying diseases and the medications used to treat the disease may cause bone loss. It is important to speak to your healthcare provider about the benefits and risks of the medications that you take. Never stop or change the way that you take your medication without consulting your healthcare provider.
How do I know if I am at increased risk for osteoporosis?
It is important for you to consider of all your personal risk factors for osteoporosis. Using the appropriate NYSOPEP risk assessment tool, “Risk Assessment for Premenopausal Women“, for “Postmenopausal Women” or for “Men” will help you better understand your risk factors for bone loss or osteoporosis.
When is a bone density test recommended for individuals with arthritis?
In general, bone mineral density testing is recommended for the following individuals:
- Men and women aged 60 or older
- Women under age 60 who have reached menopause and have risk factors for osteoporosis (such as family history of osteoporosis, being small and thin, and/or smoking)
- Adults who break a bone after age 50 or have lost more than 1 ½ inches of height
- Adults over age 50 with a disease or medical condition associated with low bone mass or bone loss
- Adults over age 50 taking medications associated with low bone mass or bone loss
The decision to have a BMD test should be made in collaboration with your healthcare provider and may not be affected by you having arthritis. If a bone density test is recommended for you, you will need a prescription from your healthcare provider.
When I am being treated for arthritis, how can I protect my bones?
You can make lifestyle choices that promote stronger bones at any age. The steps to stronger bones for life include:
Eat a variety of healthy (nutrient-rich) foods. Make half your plate vegetables and fruit, add lean protein, include whole grains, select heart-healthy fats, and remember to include a calcium-rich food or drink at each meal. For more information about healthy food choices, go to www.choosemyplate.gov
Reach and maintain a healthy weight. Eat the amount of calories and protein you need. The amount that you need will depend on your height, weight, age, and general health.
Get the calcium you need. It is recommended that adults consume 1000 to 1200 milligrams (mg) of calcium each day. It is best to get calcium from the foods you eat. Foods rich in calcium such as low fat dairy foods (milk, yogurt, cheese), dark green leafy vegetables (bok choy, broccoli, collard greens, kale, mustard greens, and turnip greens), canned fish (sardines, salmon) eaten with bones, or calcium-fortified (with calcium added) foods. The body uses calcium best when it is spaced through the day. Try to eat a calcium rich food at each meal or snack. If you think that you are not getting the recommended amount of calcium in the foods you eat, it is important to consult with your healthcare provider to find out if a calcium supplement is right for you. Calcium supplements should not be taken without the advice of your healthcare provider. Too much calcium taken on a routine basis, particularly from supplements, may be harmful.
Get the recommended amount of vitamin D. There are only a few good natural sources of vitamin D including fatty fish such as catfish, eel, mackerel, salmon, sardines, tuna and shiitake mushrooms. Small amounts of vitamin D are added to all cow’s milk, some types of beverages (almond, coconut, rice, or soy beverages and orange juice), yogurt, cheese, and nutrition bars. Adults under 50 years of age should consume 400-800 international units (IU) or 10-20 micrograms (mcg) of vitamin D daily. Adults 50 years of age and above should consume 800-1000 IU or 20-25mcg daily. Your healthcare provider may recommend more vitamin D than above stated amounts based on your individual needs.
Be physically active. Your bones get stronger and denser when you make them work. Walking, climbing stairs, and dancing are impact (or weight-bearing) exercises that strengthen your bones by moving your body against gravity when you are standing. Resistance exercises such as lifting weights or using exercise bands strengthens your bones and your muscles too! Tai Chi is an example of physical activity that improves posture and balance to help decrease the risk for falls and fractures. Exercise can be easy; try 10 minutes at a time, adding the minutes up to reach your goal.
Don’t smoke. If you do, STOP. Call 1-800-NYQUITS for information about how to quit.
Limit alcohol. Before drinking alcohol, it is important to speak to your healthcare provider about possible interactions with your medication or your medical condition. Too much alcohol can be harmful for your bones and your overall health.
Take action to prevent falls. Most broken bones occur as a result of a fall that can be prevented. Some actions to prevent falls at home include using nightlights, removing or securing scatter rugs, and getting rid of clutter.
If you are diagnosed with osteoporosis, you still must continue to make bone healthy lifestyle choices. However, lifestyle modifications alone are often not enough. Your healthcare provider may tell you that you need an osteoporosis medication to help stop further bone loss and to reduce your risk for broken bones.
For more information about arthritis in New York State, click on the NYSDOH website; http://www.health.state.ny.us/diseases/conditions/arthritis/index.htm.