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Osteologie 2021; 30(04): 326-334
DOI: 10.1055/a-1648-4414
Review

Osteoporosis and Rheumatoid Arthritis-Diagnosis, Diagnostics and Therapy

Osteoporose und Rheumatoide Arthritis-Diagnose, Diagnostik und Therapie
Bjoern Buehring 
1   Rheumazentrum Ruhrgebiet, Ruhr-Universitat Bochum Medizinische Fakultät, Herne, Germany
,
Friederike Thomasius
2   Frankfurter Hormon & Osteoporosezentrum, Frankfurt, Germany
,
Katharina Schultz
3   Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
,
Uwe Maus
3   Klinik für Orthopädie und Unfallchirurgie, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
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Abstract

Many inflammatory rheumatic diseases are associated with an increased fracture risk. Causes include the pro-inflammatory cytokines which are elevated in these diseases, reduced mobility and physical activity often caused by joint pain, and medications that negatively affect bone quality. Osteoporosis, the loss of bone mass and structure is the result. This review article summarizes the current diagnostic and therapeutic osteoporosis recommendations for patients with rheumatoid arthritis. It should be emphasized that early measures for the detection and treatment of osteoporosis are particularly important, since the risk factor constellation often present in this patient population leads to a relatively high imminent fracture risk at the beginning of the disease and the start of glucocorticoid therapy. Treatment initiations as early as possible with effective control of inflammatory activity is therefore essential to reduce the risk of osteoporosis. The administration of glucocorticoids should be reduced as far as the clinical context allows. Fracture risk should be assessed when the RA diagnosis is made and in regular intervals thereafter. Osteoporosis medication should be initiated based on the overall fracture risk. The choice of medication is based on the particular risk and indication. The basis of therapy is an adequate intake of vitamin D and calcium and adapted physical activity

Zusammenfassung

Viele entzündlich-rheumatische Erkrankungen sind mit einem erhöhten Frakturrisiko verbunden. Zu den Ursachen gehören die pro-inflammatorischen Zytokine, die bei diesen Erkrankungen erhöht sind, eine reduzierte Mobilität und körperliche Aktivität, die oft durch Gelenkschmerzen verursacht wird, sowie Medikamente, die die Knochenqualität negativ beeinflussen. Osteoporose, der Verlust von Knochenmasse und -struktur, ist die Folge. Dieser Übersichtsartikel fasst die aktuellen diagnostischen und therapeutischen Osteoporose-Empfehlungen für Patienten mit Rheumatoider Arthritis zusammen. Hervorzuheben ist, dass frühzeitige Maßnahmen zur Erkennung und Behandlung der Osteoporose besonders wichtig sind, da die in diesem Patientenkollektiv häufig vorliegende Risikofaktorenkonstellation zu Beginn der Erkrankung und zu Beginn der Glukokortikoidtherapie zu einem relativ hohen drohenden Frakturrisiko führt. Ein möglichst frühzeitiger Behandlungsbeginn mit effektiver Kontrolle der Entzündungsaktivität ist daher essentiell, um das Osteoporoserisiko zu reduzieren. Die Gabe von Glukokortikoiden sollte so weit wie klinisch möglich reduziert werden. Das Frakturrisiko sollte bei Diagnosestellung der RA und danach in regelmäßigen Abständen beurteilt werden. Eine medikamentöse Behandlung der Osteoporose sollte auf der Grundlage des Gesamtfrakturrisikos eingeleitet werden. Die Wahl der Medikamente richtet sich nach dem jeweiligen Risiko und der Indikation. Grundlage der Therapie ist eine ausreichende Zufuhr von Vitamin D und Kalzium sowie regelmäßige körperliche Aktivität.

Key words

osteoporosis - rheumatoid arthritis - fracture - diagnosis - management

Schlüsselwörter

Osteoporose - rheumatische Erkrankungen - Fraktur - Diagnostik


Publication History

Received: 02 July 2021

Accepted: 16 September 2021

Article published online:
18 November 2021

© 2021. Thieme. All rights reserved.

Georg Thieme Verlag
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